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E.  H.  COLEGROVE, 

MEDICAL  BOOKS, 

66  Randolph  Sr.,  n.  w.  Co*.  ST»Tt, 

CHICAGO. 


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AN  EPITOME 


History  of  Medicine 


ROSWELL  PARK,  A.M.,  M.D. 

Professor  of  Suboerv  in  the  Medical  Department  ok  the  University  ok  Buffalo,  etc. 


BASED  UPON  A  COURSE  OF  LECTURES  DELIVERED  IN  THE 
UNIVERSITY  OF  BUFFALO 


SECOND  EDITION 


Illustrated  with  Portraits  and  Other  Engravings 


Philadelphia,  New  Yobk,  Chicago 
F.  A.  DAVIS  COMPANY,  PUBLISHERS 

1901 


COPYKIGHT.  1897  AND  1899. 

BY 

THE  F.  A.  DAVIS  COiffANT. 
(Registered  at  Stationers'  Hall,  London.  Eng.] 


Philadelphia.  Pa..  U.  S.  A.: 

The  Medical  Bulletin  Printing-honse. 

1916  Cberrr  Street. 


**  Destiny  Reserves  for  us  Repose  Enough.^'-— Feb,NEIi. 


TO  MY  COLLEAGUES 


MEDICAL  FACULTY  OF  THE  UNIVERSITY  OF 
BUFFALO, 

Who  Authokized  anb  Excoukaged  this  First  Attempt 

IN  THE  Medical  Schools  op  this  Country  to  Give 

Systematic   Instruction  in  the  History 

of  the  Science  which  they  Teach, 


THIS  BOOK 

Is  Dedicated. 


I 


PREFACE  TO  THE  SECOND  EDITION. 


\ 


"^ 


A 


That  a  second  edition  of  a  work  of  this  character 
should  be  called  for  within  a  year  after  the  appearance  of 
the  first  is  naturally  a  source  of  the  greatest  satisfaction  to 
its  writer,  while  it  indicates  as  well  that  his  sincere  hope 
has  been  fulfilled,  in  that  the  profession  generally  are 
manifesting  a  deep,  genuine  interest  in  the  important  sub- 
jects of  which  it  briefly  treats.  This  has  been  so  uniformly 
the  expressed  opinion  of  the  book  reviewers  that  I  have 
been  the  more  anxious  to  correct  the  trifling  errors  insep- 
arable from  the  first  appearance  of  any  book,  and  even 
venture  to  agree  with  them,  in  the  hope  that  a  larger  and 
more  comprehensive  work  may  yet  be  the  outcome  of  an 
hiterest  in  this  History  of  Medicine.  Particularly  am  I 
indebted  to  those  who  have  kindly  taken  the  trouble  to 
call  my  attention  to  a  few  inaccuracies  contained  in  the  first 
edition ;  and  I  wish  here  to  express  my  obligation  to  them 
all,  and  especially  to  Dr.  Auzal,  of  New  York,  for  kind 
services  of  this  character.  The  only  regret  of  the  author 
is  that,  in  a  work  of  this  necessarily  limited  scope,  it  is 
possible  to  give  only  what  the  title  indicates, — i.e.,  an 
epitome  of  the  history  of  medicine,  rather  than  a  more 
comprehensive  account,  which  alone  should  satisfy  the 
more  studious. 

I  have  added  a  supplementary  chapter  on  "  latro- 
theurgic  Symbolism,"  as  being  quite  germane  to  the  gen- 
eral subject  of  the  book.  It  appeared  originally  as  the 
"  Annual  Oration "  delivered  by  invitation  before  the 
Maine  Medical  Association  in  June,  1898,  and  is  sub- 
stantially reproduced  from  their  Transactions. 

Buffalo,  N.  Y.,  November,  1898. 


PREFACE. 


The  history  of  medicine  has  been  sadly  neglected  in 
our  medical  schools.  The  valuable  and  fruitful  lessons 
which  it  tells  of  what  not  to  do  have  been  completely  dis- 
regarded, and  in  consequence  the  same  gross  errors  have 
over  and  over  been  repeated.  The  following  pages  repre- 
sent an  effort  to  bring  the  most  important  facts  and  events 
comprised  within  such  history  into  tlie  compass  of  a  med- 
ical curriculum,  and,  at  the  same  time,  to  rehearse  them  in 
such  manner  that  the  book  may  be  useful  and  acceptable 
to  the  interested  layman^ — i.e.,  to  popularize  the  subject. 
This  effort  first  took  form  in  a  series  of  lectures  given  in 
the  Medical  Department  of  the  University  of  Buffalo. 
The  subject-matter  of  these  lectures  has  been  rearranged, 
enlarged,  and  edited,  in  order  to  make  it  more  presentable 
for  easy  reading  and  reference.  I  have  also  tried,  so  far 
as  1  could  in  such  brief  space,  to  indicate  the  relationship 
which  has  ever  existed  between  medicine,  philosophy, 
natural  science,  theology,  and  even  belles-lettres.  Par- 
ticularly is  the  history  of  medicine  inseparable  from  a  con- 
sideration of  the  various  notions  and  beliefs  that  have  at 
times  shaken  the  very  foundation  of  Christendom  and  the 
Church,  and  for  reasons  which  appear  throughout  the 
book. 

The  history  of  medicine  is  really  a  history  of  human 

en'or   and   of  human    discovery.      During   the   past    two 

thousand   years   it  is   hard  to    say  which  has  prevailed. 

Notwithstanding,  had  it  not  been  for  the  latter  the  total 

(vi) 


PREFACE.  VU 

of  the  former  would  have  been  vastly  greater.  A  large 
part  of  my  effort  has  been  devoted  to  considering  the 
causes  which  conspired  to  prevent  the  more  rapid  develop- 
ment of  our  art.  If  among  these  the  frowning  or  for- 
bidding attitude  of  the  Church,  figures  most  prominently,  it 
must  not  be  regarded  as  any  expression  of  a  quarrel  with 
the  Church  of  to-day.  But  let  any  one  interested  read 
President  White's  History  of  the  Warfare  of  Scieiice  with 
Theology^  the  best  presentation  of  the  subject,  and  he  can 
take  no  issue  with  my  statements. 

Reverence  for  the  true,  the  beautiful,  and  the  good  has 
characterized  physicians  in  all  times  and  climes.  But  little 
of  the  true,  tlie  beautiful,  or  the  good  crept  into  the  trans- 
actions of  the  Church  for  many  centuries,  and  we  suffer, 
to-day,  more  from  its  interference  in  time  past  than  from 
all  other  causes  combined.  The  same  may  be  said  of  the- 
ology, which  is  as  separate  from  religion  as  darkness  from 
light.  Only  when  students  of  science  emancipated  them- 
selves from  the  prejudices  and  superstitions  of  the  theo- 
logians did  medicine  make  more  than  barely  perceptible 
progress. 

In  this  connection  I  would  like  to  quote  a  paragraph 
from  an  article  by  King,  in  the  Nineteenth  Century  for 
1893:  "The  difficulties  under  which  medical  science 
labored  may  be  estimated  from  the  fact  that  dissection  was 
forbidden  by  the  clergy  of  the  Middle  Ages  on  the  ground 
that  it  was  impious  to  mutilate  a  form  made  in  the  image 
of  God.  We  do  not  find  this  pious  objection  interfering 
with  such  mutilation  when  effected  by  means  of  the  rack 
and  wheel  and  such  other  clerical,  rather  than  medical, 
instruments." 

Written    history  is,  to  a  certain  extent   at  least,  pla- 


Vlll  PREFACE. 

giarism ;  and  I  make  no  apology  for  having  borrowed  my 
facts  from  uliatever  source  could  best  furnish  tliem,  but 
wish  cheerfully  and  publicly  to  acknowledge  my  indebted- 
ness to  the  wDrks  mentioned  below,  those  especially  of 
lienouard,  Baas,  and  Sprengel,  and  to  various  biographical 
dictionaries.  1  have  not  even  scrupled  to  take  bodily 
sentences  or  expressions  from  these  authorities,  but  have 
tried  to  so  indicate  them  when  I  could. 

The  writer  takes  pleasure  in  acknowledging  here  the 
obligations  which  both  he  and  the  publishers  feel  to  Dr. 
Joseph  H.  Hunt,  of  Brooklyn,  X.  Y.,  from  whose  extensive 
and  valuable  collection  have  been  furnislied  the  originals 
for  most  of  the  portraits  in  the  following  pages,  and  to  Dr. 
F.  P.  Henry,  Honorary  Librarian  of  tlie  College  of  Phy- 
sicians of  Philadelphia,  through  whose  courtesy  was 
obtained  the  privilege  of  reproducing  the  illustrations  of 
instruments  and  operations  from  some  of  the  rare  old 
works  in  the  college  library.  The  kind  co-operation  of 
these  gentlemen  has  given  a  distinct  and  added  value  to 
the  contents  of  this  little  work. 

List  of  Prinxiiwl  AVorks  Consulted. 

Baas,  Outlines  of  the  History  of  Medicine.  Translated  by  Handerson.  New- 
York,  1889. 

Berdoe,  Origin  and  Grorrth  of  the  HeaJiny  Art.     I^ndon.  1893. 

Fk)UCHTT.  Histoire  de  la  Medecine.     Paris,  1873. 

Dezeimeris,  Lettres  stir  rHiaioire  de  la  Medecine.     Paris,  1838. 

Didionnaire  Hidoriqiie  de  la  Medecine.     Paris,  1828. 

GuRLT,  Geschichte  der  Chirurgie. 

Haeser,  Geschichte  der  Medicin.     .Tena.  1K53. 

HiRSCH,  Biographtsches  Lecikon  dex  Herrorragenden  der  Aerzte  alter  Zeiten  und 
Volker.     Wien  und  Leipzig,  1884. 

Paget,  Geschichte  der  Medicin. 

Portal,  Histoire  de  VAnatomie  et  de  la  Chirurgie.     Paris,  1770. 

SorTH,  Memorials  of  the  Craft  of  Surgery  in  England.     London,  1886. 

Sprexoel,  Geschichte  der  Chirurgie.     Halle,  1819. 


CONTENTS. 


CHAPTER  I. 

PAOB 

Medicine  Among  the  Hebrews,  the  Egyptians,  the  Orientals,  the  Chinese, 
and  the  Early  Greeks. — The  Asclepiadsc. —  Further  Arrangement 
into  Periods  (Renoixard's  Classilication ) .  The  Age  of  Founda- 
tion.— Tlie  Primitive  ;  Sacred,  or  Mystic  ;  and  Philosophic  Periods. 
— Systems  in  Vogue  :  Dogmatism,  Methodism,  Empiricism,  Eclec- 
ticism.— Hippocrates 1-29 


CHAPTER  II. 

AOE  OF  FOUXDATIOX  {continued). — Anatomic  Period:  Influence  of  the 
Alexandrian  Library.  Herophilus  and  Erasistratus.  Aretaeus.  Cel- 
sus.  Galen.  —  Empiricism:  Asclepiades. —  3Iethodism  :  Themison. 
— Eclecticimn.  Age  of  Tbansitiox. — Greek  Period:  Oribasius. 
jEtius.     Alexander  of  Tralles.     Paulus  ^gineta 30-56 


CHAPTER  III. 

Age  of  Transition  {continued). — Arabic  Period:  Alkindus.  Mesne. 
Rhazes.  Haly-Abbas.  Avicenna.  Albucassis.  Avenzoar.  Averroes. 
Maimonides. — School  of  Htdc mum  :  Constantinus  Africanus.  Roger 
of  Salerno.  Roland  of  Parma.  The  Four  Mastei-s.  John  of 
Procida 57-85 


CHAPTER    IV 

Age  of  Transition  {concluded). — The  School  of  MontpeUier:  Raimond 
Lulli.  John  of  Gaddesden.  Arnold  of  Villanova.  Establishment 
of  Various  Univereities.  Gerard  of  Cremona.  "William  of  Salicet. 
I^nfranc.  Mondino.  Guy  de  Chauliac.  Age  of  Renovation. — 
Erudite  Period,  including  the  Fifteenth  and  Sixteenth  Centuries. 
Thomas  Linacre.  Sylvius.  Vesalins.  Columbus.  Eustachius. 
Fallopius.     Fabric'ius  ab  Aquapendente.     Fabricius  Hildanus.  86-113 


CHAPTER  V. 

Age  of  Renovation  {continued). — Erudite  Period  {continued) :  Beni- 
vieni.     Jean  Fernel.     Porta.     Severino.     Incorporation  of  Brother- 


(ix) 


CONTENTS. 

PAGB 

hood  of  St.  Come  into  the  Uuivei-sity  of  Paris.  Ambroise  Pare. 
Guillemean.  Influence  of  the  Ovcult  Sciences:  Agrippa.  Jerome 
Canlan.     Paracelsus.     Botal.     Joubert. 114-147 


CHAPTER    VI. 

Age  of  Rexovatiox  [cnnlhuied). — Studeut-life  During  the  Fifteenth 
and  Sixteenth  Centuries.  Ceremonials  Previous  to  Dissection. — 
Reform  Period:  The  Seventeenth,  Eighteenth,  and  Nineteenth 
Centuries.  Modern  Realism  in  Medicine  and  Science.  Introduc- 
tion of  the  Cell-doctrine.  Discover}-  of  the  Circulation.  William 
Harvey.  Malpighi.  Leeuwenhoek.  Correct  Doctrine  of  Respira- 
tion. Discovery  of  the  Lymphatic  Circulation.  The  Nervous 
System.  Discovery  of  Cinchona.  Development  in  Obstetric  Art, 
in  Jkledical  Jurisprudence,  and  in  Oral  Clinical  Teaching.  Van 
Helmont. — The  latrocheniical  Si/stem  :  Le  Biie.     Thomas  Willis.      148-170 


CHAPTER  VII. 

Age  of  Renovation  {continued). — latromechanical  School :  SaiatoTO. 
Borelli.  Sydenliam.  Sir  Thomas  Browne. — Surgery:  Denis.  F. 
Collot.  Dionis.  Baulot  (Frere  Jacques).  Scultetus.  Ran.  "Wise- 
man. Cowper.  Sir  C.  Wren  the  Discoverer  of  Hj-podemiatic 
Medication.  Anatomical  Discoveries.  General  Condition  of  the 
Profession  During  the  Seventeenth  Century.  Tlie  Eighteenth  Cent- 
ury. Boerhaave.  Gaub. — Animism:  Stahl. — Jlechnnico-dynamic 
System:  Hoffmann.  Cullen. — Old  Vienna  School:  \an  Swieten. 
De  Haen. —  Vital inm:  Bordeu.     Erasmus  Darwin 171-202 


CHAPTER  VIII. 

Age  of  Renovation  {continued). — Animal  Magnetism  :  ^lesmer.  Braid. 
— Brunonianism  :  John  Brown. — Bealism  :  Pinel.  Bichat.  Auen- 
bru^er.  Werlhof.  Frank. — Surgery:  Petit.  Desault.  Scarpa. 
Gimbernat.  Heister.  Von  Siebold.  Richter.  Hieselden.  Jlonro 
(Ist).  Pott.  John  Hunter.  B.  Bell,  J.  Bell,  C.  Bell.  Smellie. 
Denman. — Revival  of  Experimental  Study:  Haller.  Winslow. 
Portal.  Vicq  d'Azyr.  Morgagni. — Inoculation  against  Small-pox: 
Lady  Montagu.     Edwaiti  Jenner 205-229 


CHAPTER  IX. 

Age  op  Renovation  (continued). — The  Eighteenth  Century ;  General 
Considerations.  Foundation  of  Learned  Societies,  etc.  The  Royal 
College  of  Surgeons  ;  the  Josephinum. — Tlie  Nineteenth  Century 
Realistic  Reaction  Against  Pre^^ous  Idealism.  Infltience  of 
Comte,  of  Claude  Bernard,  and  of  Charles  Darwin.  Influence 
Exerte<l   by   Other  Sciences. — Theory  of  E.ix-itement :    Roeschlaub. 


CONTENTS.  XI 


— Stimolo  and  ContrasUmolo :  Rasori. — Homoeopathy:  Hahueniann. 
— Isoputhy,  ElectrvJtomwopafliy  of  Mattel. — Cranioscopy,  or  Phre- 
nology: Gall  and  Spurzheim. — The  Physiological  Theory:  Broussais. 
— Pariii  Pathological  School:  Cruveilhier.  Aiidral.  Louis.  Ma- 
gendie.  Trousseau.  Claude  Bernard. — British  Medicine :  Bell  and 
Hall.  Ti-avei-s. — Germany,  School  of  Natural  Philosophy :  Johannes 
Miiller. — School  of  Natural  History :  Schonlein. — New  Vienna  School: 
Eokitansky.     Skotla 230-259 

CHAPTER  X. 

Age  of  Rkxovation  (concluded). — New  Vienna  School  {concluded) :  von 
Hebra.  Czerniak  and  Tiirck.  Jiiger.  Arlt.  Gruber.  Politzer.— 
German  School  of  Physiological  Medicine :  Eoser. — School  of  Rational 
Medicine :  Henle. —  Pseudoparacelsism :  Radeniacher. — Hydrothera^ 
peutics:  Priessnitz. — Modern  Vitalism:  Virchow.  —  Seminalism: 
Bouchut.  —  Parasitism  and  the  Germ-theory :  Davaine.  Pasteur. 
Chauveau.  Klete.  F.  J.  Cohn.  Koch.  Lister. — Advances  in 
Physical  Diagnosis :  Laennec.  Piorry. — SURGERY  :  Delpech.  Stro- 
meyer.  Sinis.  Bozeman.  McDowell.  Boyer.  Larrey.  Dupuytren. 
Cloquet.  Civiale.  Vidal.  Velpeau.  Malgaigne.  Nelaton.  Sir 
Astley  Cooper.  Brodie.  Guthrie.  Syme.  Simpson.  Langenbeck. 
Billroth.     . 253-275 

CHAPTER  XL 

History  of  Medicine  ix  America.  —  Tlie  Colonial  Physicians. 
Medical  Study  under  Preceptors.  Inoculation  against  Sniall-i)OX. 
Military  Surgery  During  the  Revolutionary  War.  Earliest  Med- 
ical Teaching  and  Teachei-s  in  this  Country.  The  First  Medical 
Schools.  Benjamin  Rush.  The  First  Medical  Journals.  Brief 
List  of  the  Best-Known  American  Physicians  and  Surgeons.      •      276-299 

CHAPTER  XIL 

The  History  of  Anesthesia. — Anaesthesia  and  Analgesia.  Drugs 
Possessing  Narcotic  Properties  in  \ise  since  Prehistoric  Times. 
Mandragora ;  Hemp  ;  Hasheesh.  Sulphuric  Ether  and  the  Men 
Concerned  in  its  Introduction  as  an  Anajsthetic — Long,  .Jackson, 
AVells,  and  Morton.  Morton's  First  Public  Demonstration  of  the 
Value  of  Ether.  Morton  Entitled  to  the  Credit  of  its  Introduc- 
tion. Chloroform  and  Sir  James  Simpson.  Cocaine  and  Karl 
Koller 300-316 

CHAPTER    XIII. 

The  History  of  Antisepsis. — Sepsis,  Asepsis,  and  Antisepsis.  The 
Germ-theory  of  Disease.  Gay-Lussac's  Researches.  Schwann. 
Tyndall.     Pasteur.     Davaine.     Lord  Lister  and  his  Epoch-making 


Xll  CONTENTS. 

PAGK 

Kevolution  iu  Surgical  Methods.  Modifications  of  his  Earliei- 
Technique  without  Cliauge  in  Underlying  Principles,  Avhich  Still 
Eemain  Unshaken.  Changes  Effected  in  Consequence.  Com- 
parison of  Old  and  ^Modern  Statistics 31&-329 

CHAPTER  XIV. 

An  Epixome  op  the  History  op  Dentistry. — Rude  Dentistry  of 
Prehistoric  Times.  Early  Instruments  for  Extraction  Made  of  Lead. 
Dentistry  on  the  Same  Imw  Plane  as  ^ledicine  During  the  First 
Half  of  the  Christian  Era.  Dentistry  Taught  at  the  School  of 
Salernura.  Progress  of  the  Art  on  the  Continent.  Prosthesis  and 
Substitutes  for  Human  Teeth.  Introtluctioii  of  Porcelain  for  Arti- 
ficial Teeth  ;  of  Metal  and  of  Vulcanized  Rubl>er  for  Plates  ;  of 
Plaster  for  Impressions.  From  being  a  Tratle,  Dentistry  is  now  a 
Profession,  iu  which  Americans  lead  the  World.     Statistics.    .    .      330-341 

CHAPTER  XV. 
Iatrotheuegic  Symbolism 342-364 


LIST  OF  ILLUSTRATIONS. 


no.  PAGB 

1.  .^^ulapius, 7 

2.  Offering  to  ^Esculapius, 9 

3.  Hippocrates,                    19 

4.  Aulus  Cornelius  Celsus, 35 

5.  The  Convei-sion  of  Galen, 37 

6.  Averroes,              64 

7.  Andreas  Vesalius, 105 

8.  Title-page  of   The  Seven  Bools  of  the  Anatomy  of  the  Human  Body, 

by  Andreas  Yesalius,  of  Bnissels,  Physician  to  the  Invincible 

Emperor  Charles  V, 106 

9.  IV,  Forceiw  for  Extracting  Balls.     F,  A  Denticulated  Form  of  Forceps  108 

10.  Gabriel  Fallopius, 109 

11.  Forms  of  Forcei>s  for  Enlarging  Wounds, Ill 

12.  Botly  .Showing  Various  Kinds  of  Wounds, 117* 

13.  Mode  of  E-xti-acting  Leaden  Bullets, 121 

14.  Ambroise  Pare,                                              124 

15.  Pliers,  Iron  for  Actual  Cautery,  and  Seton-needles,       126 

16.  Swan's  lieak,  Used  for  Dilating  the  Track  of  a  Wound  and  Extracting 

a  Foreign  Body,                 129 

17.  Various  Instruments  for  the  Extraction  of  Balls,  : 131 

18.  Specuiums  for  the  Mouth  and  Womb,  etc., 133 

19.  Amputation  Instruments,        135 

20.  Different  Foi-ms  of  Trephines  and  Pliers, 137 

21.  Philip  Theophi-astus  Paracelsus, 143 

22.  William  Harvey,  M.D., .  156 

23.  Thomas  Sydenham, 173 

24.  Straight  Saws  and  Divers  Scraping  Tools,  Wlierewith  the  Skull,  Being 

Rotten  or  Having  a  Fissure,  is  Scraped  Away,       179 

25.  Surgical  Treatment  of  Certain  Dislocations,            181 

26.  Vai-ious  Operations  on  the  Arms  and  Lower  Limbs, 185 

27.  Surgical  Openitions  on  the  Breast,  etc., 187 

28.  Boerhaave,                . 193 

29.  John  Brown,  M.D., 205 

30.  Ph.  Pinel,                                    207 

31.  Marie  Fi-an(;ois  Xavier  Bichat,  M.D., 208 

32.  William  Hunter,  M.D.,  F.R.S., 217 

33.  John  Hunter,                      218 

34.  J.  F.  Blumenbach, 223 

35.  Edward  Jenner,  :M.D., 227 

36.  Samuel  Hahnemann,      242 

37.  Kudolph  Virehow,              257 

38.  Bernhard  von  Langenbeck, 265 

39.  Tlieofior  Billroth, 266 

(xiii) 


XIV  LIST   OF   ILLUSTRATIONS. 

FIG.  PAGE 

40.  Su- Astley  Cooper,  Bart., 272 

41.  Sir  Benjaniiu  Collius  Brodie,  Bart.,  F.R.S.,     .    .    .    .    „ 273 

42.  B.  Wattrhouse,  M.D.,                                                  280 

43.  Surgeon's  Hall,  next  to  Philadelphia  Dispensary,  Fifth  Street  below 

Library  Street, 281 

44.  Benjamin  Rnsli,  M.D 284 

45.  George  B.  AVood.  M.D., 286 

46.  Robley  Dunglison,  M.D., 287 

47.  Austin  Flint,  M.D., 288 

48.  John  Ray,  M.D.,        289 

49.  Philip  Syng  Physick,  M.D., 291 

50.  Ephraim  McDowell,  M.D., 292 

51.  S.  D.  Gross,  M.D.,  LL.D., 294 

52.  J.  Marion  Sims,  M.D.,          296 

53.  D.  Hayes  Agnew,  M.D.,  LL.D., 297 

54.  William  T.  G.  Morton,  M.D., 307 

55.  Dr.  Morton  Making  the  First  Public  Demonstration  of  Etherization  at 

the  ^Massachusetts  General  Hospital  Surrounded  by  the  ^ledical 

Staff  of  that  Institution,  October  16,  1846, 309 

56.  Lord  Lister,  M.D.,  D.C.L.,  LL.D.,  P.R,S., 323 


An  Epitome  of  the  History  of  Medicine. 


CHAPTER  I. 

Medicine  Among  the  Hebrews,  the  Egyptians,  the  Orientals,  the  Chinese,  and 
the  Early  Greeks. — The  Asclepiada\ — Further  Arrangement  into  Periods 
( Renouard '  s  Classi  tication ) . 

The  Age  of  Fouxdatiox. — The  Primitive  ;  Sacred,  or  Mystic  ;  and  Philo- 
sophic Periods. — Systems  in  Vogue:  Dogmatism,  Methodism,  Empiricism, 
Eclecticism. — Hippocrates,  born  460  B.C. 

Of  the  origin  of  medicine  but  little  need  be  said  by  way 
of  preface,  save  tbat  it  must  liave  been  nearly  contempo- 
raneous witli  the  origin  of  civilization.  The  lower  animals 
when  sick  or  wounded  instinctively  lessen  or  alter  their 
diet,  seek  seclusion  and  rest,  and  even  in  certain  cases  seek 
out  some  particular  herb  or  healing  substance.  Thus,  too, 
does  the  savage  in  his  primitive  state;  and  experience  and 
superstition  together  have  led  nearly  all  the  savage  tribes 
into  certain  habits  and  forms  in  case  of  injury  or  disease. 
For  us  the  history  of  medicine  must  necessarily  begin 
with  the  written  history  of  events,  and  its  earliest  endeavors 
need  detain  us  but  a  very  short  time.  Its  earliest  period 
is  enveloped  in  profound  obscurity,  and  so  mingled  with 
myth  and  fable  as  to  be  very  uncertain.  It  embraces  an 
indefinite  time,  during  which  medicine  was  not  a  science, 
but  an  undigest(^d  collection  of  exi)erimental  notions, — 
vaguely  described,  disfigured  by  tradition,  and  often  made 
inutile  by  superstition  and  ignorance.  Among  the  earliest 
records  of  probable  autlienticity  are  perhaps  the  Script- 
ures, from  which  may  be  gatliered  here  and  there  a  fair 
notion  of  Egyptian  knowledge  and  practice.  Thus  we  read 
that  Joseph  commantled  his  servants  and  physicians  to 
embalm  him,  this  being  about  1700  B.C.  It  shows  that 
Egvpt  at  that  time  possessed  a  class  of  men  who  practiced 

(I) 


2  THE    HISTORY    OF    MEDICINE. 

the  healing  art,  and  that  tliey  also  embalmed  the  dead, 
which  must  have  both  required  and  furnished  a  crude  idea 
of  general  anatomy.  We  are  also  informed  from  other 
sources  that  so  superstitious  were  the  Egyptians  that  they 
not  only  scoffed  at,  but  would  stone,  the  embalmers,  for 
whom  they  had  sent,  after  the  completion  of  their  task. 
The  probably  mythical  being  whom  the  Egyptians  called 
Thoth,  whom  the  Greeks  named  Hermes  and  the  Latins 
Mercury,  passed  among  the  Egyptians  as  the  inventor  of 
all  sciences  and  arts.  To  him  are  attributed  an  enormous 
number  of  writings  concerning  all  subjects.  Some  have 
considered  him  as  identical  with  Bacchus,  Zoroaster,  Osiris, 
Isis,  Serapis,  Apollo,  and  even  Shem,  the  son  of  Noah. 
Others  have  thought  him  to  be  a  god.  It  is  now  almost 
certain  that  the  books  attributed  to  Hermes  were  not  the 
work  of  any  one  hand  or  of  any  one  age.  The  last  six 
volumes  of  the  forty-two  composing  the  encyclopaedia, 
with  which  Hermes  is  credited,  refer  to  medicine,  and 
embrace  a  body  of  doctrines  fairly  complete  and  well 
arranged.  Of  these  six,  the  first  treats  of  anatomy;  the 
second,  of  diseases;  the  third,  of  instruments;  the  fourth, 
of  remedies;  the  fiftli,  of  diseases  of  the  eye;  and  the 
sixth,  of  diseases  of  women.  In  completeness  and  arrange- 
ment it  rivals,  if  not  surjiasses,  the  Hippocratic  collection, 
wliich  it  antedated  by  perhaps  a  thousand  years.  The 
Egyptians  appear  at  first  to  have  exposed  their  sick  in 
public  (at  least,  so  says  Strabo),  so  that  if  any  of  those  who 
passed  by  liad  been  similarly  attacked  they  miuht  give  their 
advice  for  the  benefit  of  the  sufferers.  In  fact,  according  to 
Herodotus,  the  same  custom  prevailed  among  the  Baby- 
lonians and  Lusitanians.  At  a  later  date  all  who  were 
tlius  cured  were  required  to  go  to  the  temples  and 
tliere  inscribe  tlieir  symptoms  and  wliat  had  helped  them. 
Tbe  temples  of  Canopus  and  Vulcan  at  :Memphis  became 
the  principal  depots  for  these  records,  which  were  kept  as 
carefully  as  were  the  archives  of  the  nation,  and  were  open 


MEDICINE   AMONG   THE   EGYPTIANS.  3 

for  public  reference.  These  records,  being  under  the  con- 
trol of  the  priests,  were  mainly  studied  by  them,  who  later 
collected  a  great  mass  of  facts  of  more  or  less  importance, 
and  endeavored  to  found  upon  the  knowledge  thus  col- 
lected an  exclusive  practice  of  the  art  of  medicine.  In 
this  way  they  formed  their  medical  code,  wliich  was  called 
by  Diodorus  the  Hiera  Biblos,  Sacred  Booh,  from  whose 
directions  they  were  never  allowed  to  swerve.  It  was  per- 
haps this  code  which  was  later  attributed  to  Hermes,  and 
that  made  up  the  collection  spoken  of  by  Clement  of  Alex- 
andria. If  in  following  these  rules  they  could  not  save 
their  patients  they  were  held  blameless,  but  were  punished 
with  death  if  any  departure  from  them  were  not  followed 
by  success. 

I  have  spoken  of  embalming  as  practiced  by  the 
Egyptians.  It  was  of  three  grades :  the  first  reh^erved 
for  men  of  position  and  means,  which  cost  one  talent, 
and  according  to  which  the  brain  was  removed  by  an 
opening  through  tlie  nasal  fossee,  and  the  intestines  through 
an  opening  on  the  left  side  of  the  abdomen,  after  wliich 
both  cavities  were  stuifed  with  spices  and  aromatics ;  then 
the  body  was  washed  and  spread  over  with  gum  and 
wrapped  in  bandages  of  linen.  The  second  grade  was 
adopted  by  families  of  moderate  means ;  and  the  third  was 
resorted  to  by  the  poor,  consisting  simply  in  the  washing 
of  tlie  body  and  maceration  in  lye  for  seventy  days. 

Pliny  assures  us  that  the  kings  of  Egypt  permitted 
the  opening  of  corpses  for  the  purpose  of  discovering  the 
causes  of  disease,  but  this  was  only  permitted  by  the 
Ptolemies,  under  whose  reign  anatomy  was  carried  to  a 
very  high  degree  of  cultivation.  The  papyri  discovered 
recently  by  Ebers  depict  the  time  of  Rameses  II. 

The  medicine  of  the  Hebrews  is  known  generally 
through  the  Sacred  Scriptures,  esi)ecially  through  the  writ- 
ings attributed  to  Moses,  which  embraced  rules  of  the  high- 
est sagacity,  especially  in   public  hygiene.     The  book  of 


4  THE    HISTORY    OF    MEDICINE. 

Leviticus  is  largely  made  up  of  rules  concerning  matters 
of  public  health.  In  the  eleventh  chapter,  for  instance, 
meat  of  the  rabbit  and  the  hog  is  proscribed,  as  apparently 
injurious  in  the  climate  of  Egypt  and  India ;  it,  however, 
has  been  suggested  that  there  was  such  variation  of  names 
or  interpretation  thereof  as  to  make  it  possible  that  our 
rabbit  and  hog  are  not  the  animals  alluded  to  by  Moses. 
The  twelfth  and  fifteenth  chapters  of  the  same  book  were 
designed  to  regulate  the  relation  of  man  and  wife  and  the 
purification  of  women,  their  outlines  being  still  observed  in 
some  localities  by  certain  sects,  while  the  hygienic  measure 
of  circumcision  then  insisted  upon  is  still  observed  as  a 
religious  rite  among  the  descendants  of  Moses.  For  the 
prevention  of  the  spread  of  leprosy,  the  measures  suggested 
by  Moses  could  not  now  be  surpassed,  although  ancient 
authors  have  confounded  under  this  name  divers  affections, 
probably  including  syphilis,  to  which",  however,  the  same 
hygienic  rules  should  apply.  Next  to  Moses  in  medical 
lore  should  be  mentioned  Solomon,  to  whom  is  attributed 
a  very  high  degree  of  knowledge  of  natural  history,  and 
who,  Josephus  claimed,  had  such  perfect  knowledge  of  the 
properties  of  all  the  productions  of  nature  that  he  availed 
himself  of  it  to  compound  remedies  extremely  useful,  some 
of  which  had  even  the  virtues  necessary  to  cast  out  devils 

The  most  conspicuous  feature  in  the  life  of  the  Indian 
races  is  their  division  into  castes,  of  which  the  most  noble  is 
that  of  the  priests,  or  Brahmins,  who  in  ancient  times  alone 
had  the  privilege  of  practicing  medicine.  Their  Organon 
of  Medicine,  or  collection  of  medical  knowledge,  was  a 
book  wliich  they  called  Vagadasastir.  It  was  not  sys- 
tematically arranged,  and  in  it  deraonology  played  a  large 
role.  They  held  the  human  body  to  consist  of  100,000 
parts,  of  which  17,000  were  vessels,  each  one  of  which  was 
composed  of  seven  tubes,  giving  passage  to  ten  species  of 
gases,  whicli  by  their  conflicts  engendered  a  number  of  dis- 


MEDICINE   AMONG    THE    ORIENTALS.  5 

eases.  They  placed  the  origin  of  the  pulse  in  a  reservoir 
located  behind  the  umbilicus.  This  was  four  fingers  wide 
by  two  long,  and  divided  into  72,000  canals,  distributed  to 
all  parts  of  the  body.  The  physician  examined  not  only 
the  pulse  of  his  patient,  but  the  dejecta,  consulted  the  stars, 
the  flight  of  birds,  noted  any  incidental  occurrence  during 
his  visits,  and  made  up  his  prognosis  from  a  multitude  of 
varying  circumstances,  omitting  only  those  which  were 
really  valuable,  namely,  tlie  symptoms  indicating  the  state 
of  the  organs.  Ancient  Hindoo  charlatan  priests  let  fall 
from  the  end  of  a  straw  a  drop  of  oil  into  the  patient's 
water.  If  the  oil  was  precipitated  and  attached  itself  to 
the  bottom  of  the  vessel,  they  predicted  an  unfavorable 
result;  if,  on  tlie  contrary,  it  floated,  they  gave  a  favorable 
prognosis.  This  is,  so  far  as  we  know,  the  earliest  recorded 
way  of  testing  the  specific  gravity  of  the  urine. 

With  all  their  absurdities,  however,  the  Indians  appear 
to  have  done  some  things  that  we  scarcely  do  to-day:  they 
are  said  to  have  had  an  ointment  that  caused  tlie  cicatrices 
of  variola  to  disappear,  and  they  cured  the  bites  of  venom- 
ous serpents  with  remedies  whose  composition  has  been 
lost. 

The  antiquity  of  the  Chinese  is  simply  lost  in  tradition 
and  fable.  From  time  immemorial  their  rulers  have  taken 
extraordinary  care  to  prevent  contact  and  interchange  of 
ideas  with  foreigners.  For  4000  years  their  manners, 
laws,  religious  beliefs,  language,  and  territory  have  scarcely 
changed.  In  tliis  respect  they  stand  alone  among  the 
nations  of  the  earth.  They  attribute  the  invention  of 
medicine  to  one  of  their  emperors  named  Hwang-ti,  who  was 
the  third  of  the  first  dynasty,  and  whose  supposititious  date 
is  2687  B.C.  He  is  considered  to  be  the  author  of  the  work 
which  still  serves  them  as  a  medical  guide.  It  is,  however, 
more  probably  an  apocryphal  book.  Its  philosophy  was 
of  a  sphygmic  kind, — i.e.,  based  upon  the  pulse,  which  they 


6  THE    HISTORY    OF    MEDICINE. 

divided  into  the  supreme  or  celestial,  the  middle,  and  the 
inferior  or  terrestrial ;  by  the  examination  of  which  the 
Chinese  physician  was  supposed  not  only  to  show  the  seat 
of  disease,  but  to  judge  of  its  duration  and  gravity.  It  is 
related  that  one  of  the  ancient  Chinese  emperors  directed 
the  dead  bodies  of  criminals  to  be  opened,  but  this  is  ques- 
tionable, since  it  is  certain  that  they  have  the  most  pro- 
found ignorance  of  rudimentary  anatomy,  and  glaring  errors 
abound  in  their  system.  Being  thus  replete  with  errors, 
and  possessing  no  anatomical  knowledge,  their  surgery  was 
of  the  most  barbarous  type.  No  one  dared  attempt  a 
bloody  operation  ;  the  reduction  of  hernia  was  unknown  ; 
a  cataract  was  regarded  as  beyond  their  resources ;  and 
even  venesection  was  never  practiced.  On  the  other  hand, 
they  employed  cups,  and  acupuncture,  fomentation,  plasters 
of  all  kinds,  lotions,  and  baths.  The  moxa,  or  red-hot 
button,  was  in  constant  use,  and  they  had  their  magnetizers, 
Avho  appear  to  have  been  convulsionists.  For  a  long  time 
there  existed  at  Pekin  an  Imperial  School  of  Medicine,  but 
now  there  is  no  such  organization  nor  any  regulation  for  the 
privilege  of  practicing  medicine  or  surgery  since  1792.  At 
least  until  lately  the  country  and  the  cities  were  infested 
with  quacks,  who  dealt  out  poison  and  death  with  im- 
punity. They  practiced  most  murderous  methods  in  place 
of  the  principles  of  midwifery.  Only  since  the  civilized 
missionaries  have  penetrated  into  their  country  has  there 
been  any  improvement  in  this  condition  of  affairs. 

It  is  Greece  which  furnishes  us  with  tJie  most  interesting 
and  the  most  significant  remains  of  the  history  of  medicine 
during  antiquity,  as  she  furnishes  every  other  art  with  the 
same  historical  advantages.  During  the  period  preceding 
the  Trojan  War  there  is  little  but  myth  and  tradition. 
Leclerc  catalogued  some  thirty  divinities,  heroes  or 
heroines,  who  were  supposed  to  have  invented  or  culti- 
vated  some  of  tho  branches  of  medicine.     ^Nfelampus    is 


MEDICINE    AMONG    THE   GREEKS.  7 

perhaps  the  first  of  these  who  imraortahzed  himself  by 
extraordinary  cures,  especially  on  the  daughters  of  Proetus, 
King-  of  Argos.  These  young  princesses,  liaving  taken 
vows  of  celibacy,  became  subjects  of  hysterical  monomania, 
with  delusions,  during  which  they  imagined  themselves 
transformed  into  cows  and  roamed  the  forests  instead  of 
the  palaces.  This  nervous  delusion  spread  to  and  involved 
many    other    women,    and     became     a    serious     matter. 


Fig.  1.— wS^.scclapius. 
(From  a  steel  engraving  of  the  marble  statue  in  the  Louvre.)  ' 

Melampus,  the  shepherd,  liaving  observed  the  purgative 
effects  upon  goats  of  white  hellebore,  gave  to  the  young 
women  milk  in  wliich  this  plant  had  been  steeped,  thereby 
speedily  effecting  a  cure.  Scarcely  less  distinguished  than 
Melampus  was  C|hiron.  He  was  mainly  distinguished 
because  he  was  the  preceptor  of  JEsculapius,  the  most 
eminent  of  early  Greeks  in  this  field.  By  some  JEsculapius 
was  considered  the  son  of  Apolh:)  by  the  nymph  Coronis, 


8  THE    HISTORY    OF    MEDICINE. 

Several  cities  of  Greece  contended  for  the  honor  of  his 
birthplace,  as  they  did  for  that  of  Homer.  That  he  was 
famous  at  the  time  of  the  Argonantic  expedition  is  seen  by 
the  fact  that  the  twins  Castor  and  Pollux  desired  him  to 
accompany  the  expedition  as  surgeon.  Be  his  origin  what 
it  may,  ^sculapius  was  the  leading;  character  in  medicine 
of  all  the  ancients,  with  the  possible  exception  of  Hermes 
among  the  Egyptians;  in  fact,  some  scholars  consider  the 
two  identical.  Temples  were  erected  in  his  honor,  priests 
were  consecrated  to  them,  and  schools  of  instruction  were 
there  established.  It  is  related  that  Pluto,  god  of  hell, 
alarmed  at  the  diminishing  number  of  his  daily  arrivals, 
complained  to  Jupiter,  who  destroyed  the  audacious  healer 
— on  which  account,  some  wit  has  said,  "  the  modern  chil- 
dren of  ^sculapius  abstain  from  performing  prodigies." 
But  the  true  ^sculapians,  the  successors  of  the  demigod, 
were  imitated  or  copied  by  the  crowd  of  charlatans  and 
quacks,  calling  themselves  theosophs,  thaumaturgs,  and  so 
on,  and  not  alone  at  that  date,  but  for  generations  and 
centuries  thereafter,  Paracelsus  and  Mesmer  being  fair 
examples  of  this  class.  The  poet  Pindar,  who  lived  seven 
or  eight  hundred  years  after  ^^^sculapius,  says  that  he  cured 
ulcers,  wounds,  fever,  and  pain  of  all  who  applied  to  him 
by  enchantment,  potions,  incisions,  and  by  external 
applications.^ 

The  followers  of  JEsculapius,  and  the  priests  in  the 
temples  dedicated  to  him,  soon  formed  a  se[)arate  caste, 
transmitting  from  one  to  another,  as  a  fnmily  heritage, 
their  medical  knowledge.  At  first  no  one  was  admitted  to 
practice  the  sacred  science  unless  he  joined  the  priesthood, 
although  later  this  secrecy  was  relaxed.  They  initiated 
strangers,  provided  they  fulfilled  the  test  which  they  made. 
Some  kind  of  medical  instruction  was  given  in  each  temple. 
The  three  most  celebrated  temples  to  ^Esculapius  were 
that  of  Rhodes,  already  extinct  by  the  time  of  Hippocrates; 

'  Tliiid  Pytliian  Ode. 


^SCULAPIUS.  9 

that  of  Cnidus,  which  published  a  small  repertory;  and 
finally  that  of  Cos,  most  celebrated  of  all,  because  of  the 
illustrious  men  who  emanated  from  this  school.  In  these 
temples  votive  tablets  were  fastened  in  large  numbers,  after 
the  fashion  of  the  Egyptians,  the  same  giving  the  name  of 
the  patient,  his  affliction,  and  the  manner  of  his  cure.  For 
example,  such  a  one  as  this:  "Julien  vomited  blood,  and 
appeared  lost  beyond  recovery.     The  oracle  ordered  him  to 


r 

m 

1 

■)!          -      ■:                                              '    ^^■,               ' 

'-.  '       ■#/  ^ 

r  •, 

'             ''■                        'A'                 .            -■ 

•         '                                        :                                                                                       i' 

^ 
t 

.) 

\^ 

y'  '7    . 

Fig.  2.— Offering  to  .^sculapius. 
(From  an  engraving  by  George  Cooke  of  a  painting  by  Guerin.) 

take  the  pine-seeds  from  tlie  altar,  whicli  tliey  had  three 
days  mingled  with  honey;  he  did  so,  and  was  cured. 
Having  solemnly  thanked  the  god,  he  went  away."  There 
is  reason  to  think  that  the  priests  of  these  temples  made  for 
their  own  uses  m^ch  more  minute  and  accurate  accounts, 
whicli  should  be  of  some  real  service,  since  the  writings 
which  have  come  down  to  us  evince  a  habit  of  close  obser- 
vation and  clear  description  of  disease.     During  the  Trojan 


10  THE   HISTORY    OF    MEDICINE. 

War  tno  men  are  frequently  mentioned  by  Homer  as  pos- 
sessing great  surgical  skill.  These  were  Machaon  and 
Podalirius.  They  were  regarded  as  sons  of  ^Escidapius, 
the  former  being  the  elder.  The  first  account  of  venesec- 
tion, although  not  authentic,  refers  to  the  bleeding  practiced 
by  the  latter  upon  the  daughter  of  the  King  of  Caria,  upon 
whose  shores  Podalirius  was  cast  by  tempest  after  the  ruin 
of  Priam's  kingdom.  Whether  he  was  the  first  of  all  men 
to  practice  it  or  not,  it  is  certain  that  the  act  of  venesection 
goes  back  long  prior  to  the  era  of  Hippocrates,  who  speaks 
of  it  as  frequently  performed. 

Many  of  the  deities  upon  Olympus  seem  at  one  time  or 
another  to  have  usurped  medical  functions.  Apollo,  the 
reputed  father  of  jEsculapius,  appropriated  nearly  every- 
thing under  the  name  of  Pceon,  who  assumed  the  privilege 
of  exciting  or  subduing  epidemics.  Juno  was  supposed  to 
preside  at  accouchements,  and  in  both  the  Iliad  and  Odyssey 
it  is  indicated  that  Apollo  was  considered  as  the  cause  of 
all  the  natural  deaths  among  men,  and  Diana  of  those 
among  women. 

The  long  Trojan  War  appears  to  have  been  an  epoch- 
making  event  in  the  medical  and  surgical  history  of  those 
times,  as  was  the  Civil  War  recently  in  our  country. 
Certain  vague  and  indefinite  practices  tlien  took  more  fixed 
form,  and  from  that  time  on  medicine  may  be  said  to  have 
been  furnished  with  a  history.  After  the  dethronement  of 
Priam  and  the  destruction  of  his  capital,  navigation  was 
free  and  unrestricted.  The  Hellenists  covered  with  their 
colonies  both  shores  of  the  Mediterranean,  and  their  navi- 
gators even  passed  the  pillars  of  Hercules.  By  these  means 
the  worship  of  ^sculapius  passed  from  Greece  into  what 
is  now  Asia,  Africa,  and  Italy.  In  his  temple  at  Epidaurus 
was  a  statue  of  colossal  size  made  of  gold  and  ivory.  The 
dialogues  of  Plato,  especially  the  Phsedo,  make  it  ap- 
parent that  the  cock  was  the  animal  sacrificed  to  him,  and 
hence  sacred  to  the  god  of  medicine.     The  priests  attached 


THE    ASCLEPIAD^.  11 

to  his  worship  were  called  AscJepiadw,  or  descendants  of 
^sculapius.  The  temples  were  usually  hygieiiically 
located  near  thermal  springs  or  fountains  and  among 
groves.  Pilgrimages  were  made  from  all  quarters,  and 
these  localities  became  veritable  health-resorts.  A  well- 
regulated  dietary,  pure  air,  temperate  habits,  and  faith 
stimulated  to  a  fanatical  degree  combined  and  sufficed  for 
cures  which  even  nowadays  would  be  regarded  as  wonder- 
ful. The  priests  prescribed  venesection,  purgatives,  emetics, 
friction,  sea-baths,  and  mineral  Avaters,  as  they  appeared  to 
be  indicated.  The  imagination  of  the  patient  was  con- 
tinually stimulated,  and  at  the  same  time  controlled.  Be- 
fore interrogating  the  oracles  they  must  be  purified  by 
abstinence,  prayer,  and  sacrifice.  Sometimes  they  were 
obliged  to  lie  in  the  temple  for  one  or  more  nights.  The 
gods  sometimes  revealed  themselves  in  mysterious  ways,  at 
times  devouring  the  cakes  upon  the  altars  under  the  guise 
of  a  serpent,  or  again  causing  dreams  which  were  to  be 
interpreted  by  the  priests.  There  can  be  no  doubt  that 
sometimes,  at  least,  the  grossest  frauds  and  the  basest 
trickery  were  relied  upon  for  the  purpose  of  impressing  the 
minds  of  those  weakened  by  abstinence  or  influenced  by 
drugs.  Mercenary  considerations  were  not  lacking  ;  more- 
over, cures  were  often  not  obtained  until  zeal  had  been 
redoubled  by  largely  increased  contributions  to  the  treasury 
of  the  temples.  In  the  neighborhood  of  many  of  these 
temples  serpents  abounded,  non-venomous  and  easily  tamed. 
These  were  employed  by  the  priests  in  various  supernatural 
performances  by  which  the  ignorant  people  were  astonished 
and  profoundly  impressed.  In  fact,  the  serpent  and  the 
serpent-myth  played  a  very  large  role  in  the  early  history 
of  medicine  as  well  as  that  of  religion  and  religiouf 
symbolism. 

It  will  thus  be  seen  that  during  the  space  of  about  700 
years  medicine  underwent  a  transformation  in  Greece.  It 
was  first  domestic  and   popular,  practiced  by  shepherds, 


12  THE   HISTORY   OF    MEDICINE. 

soldiers,  and  others ;  then  became  sacerdotal ;  after  the 
Trojan  War  it  was  confined  to  the  vicinity  of  the  temples 
and  practiced  in  the  name  of  some  divinity ;  and  finally  it 
was  wrapped  in  mystery  and  mystic  symbolism,  where 
superstition  was  played  upon  and  credulity  made  to  pay 
its  reward.  Down  to  the  time  of  Hippocrates  the  Asclej> 
iadsB  rendered  some  genuine  service  to  science,  especially 
by  inculcating  habits  of  observation,  in  which  Hippocrates 
excelled  above  all.  Later,  however,  down  to  the  time  of 
the  Christian  era,  medicine  in  the  temples  declined,  and 
became,  in  fact,  a  system  based  upon  the  grossest  jugglery. 

It  is  time  now  that  we  make  a  systematic  attempt  to 
classify  events  in  the  history  of  medicine,  and  to  recognize 
certain  distinct  epochs  as  they  have  occurred.  For  this 
purpose  I  know  of  no  better  arrangement  than  that  of 
Ilenouard,  which,  in  the  main,  I  shall  follow,  at  least 
during  the  forepart  of  this  book.  In  this  sense  he  divides 
the  past  into  three  ages,  known,  respectively,  as  the 
Age  of  Foiinchition,  the  Age  of  Transition^  and  the  Age  of 
Renovation.  Each  of  these  chronological  divisions  is  sub- 
divided into  periods,  of  which  the  first  contains  four : — 

Age  of  Foundation. — 1 .  The  Primitive  Period,  or  that 
of  Instinct,  beginning  with  myth,  and  ending  with  the 
destruction  of  Troy  1184  years  before  Christ. 

2.  The  Sacred,  or  Mystic,  Period,  ending  with  the 
dispersion  of  the  Pythagorean  Society,  500  years  before 
Christ. 

3.  The  Pliilosopliic  Period,  terminating  with  the  foun- 
dation of  the  Alexandrian  library,  320  years  before  Christ. 

4.  The  Anatomic  Period,  ending  with  the  death  of 
tjfalen    ibout  a.d.  200. 

The  Second  Age,  or  that  of  Transition,  is  divided  into 
a  fifth,  or  Greeh  Period,  ending  at  the  burning  of  the  Alex- 
andrian library,  a.d.  640,  and  a  sixth,  Arabic  Period,  ending 
with  the  revival  of  letters,  a.d.  1400. 


CLASSIFICATION.  13 

The  Third  Age,  or  that  of  Renovation,  includes  the 
seventh,  or  Erudite  Period^  comprising  the  fifteenth  and 
sixteenth  centuries,  and  eighth,  or  Reform  Period^  com- 
prising the  seventeenth,  eighteenth,  and  nineteenth  cent- 
uries. 

Examining  this  table  for  a  moment,  it  will  be  seen  that 
so  far  we  have  dealt  with  the  Primitive  Period  and  the 
Sacred,  or  Mystic,  Period.  Before  passing  on  to  the  Philo- 
sophic Period  let  us  for  a  moment  follow  Renouard,  who 
likens  the  three  schools  of  medical  belief  in  the  earlier 
part  of  the  Primary  Age,  or  the  Age  of  Foundation,  to  the 
three  schools  of  cosmogony,  which  obtained  among  the 
Greeks.  The  first  of  these  was  headed  by  Pythagoras, 
who  regarded  the  universe  as  inhabited  by  acknowledged 
sentient  principles  which  governed  all  substances  in  a  de- 
termined Avay  for  preconceived  purposes.  Animals,  plants, 
and  even  minerals  were  supposed  to  possess  vivifying 
spirits,  and  above  them  all  was  a  supreme  principle.  To 
this  school  corresponded  the  so-called  Dogmatic  School  of 
medicine,  attributed  to  Plippocrates,  which  was  the  pre- 
cursor of  modern  vitalism,  and  regarded  diseases  as  in- 
divisible units  from  beginning  to  termination ;  in  other 
words,  they  consisted  of  a  regular  programme  of  character- 
istic systems,  successive  periods,  and  of  long  course,  either 
for  the  better  or  worse ;  that  was  one  of  the  characteristic 
dogmas  of  the  Hippocratic  teaching.  The  Second  System 
of  cosmogony  was  that  founded  by  Leucippus  and  Democ- 
ritus,  who  explained  all  natural  phenomena  without  re- 
course to  the  intervention  of  intelligent  principles.  All 
things  for  them  existed  as  the  necessary  result  of  the  eternal 
laws  of  matter.  They  denied  preconceived  purposes  and 
ridiculed  final  causes.  To  this  system  corresponded  that 
in  medicine  whicj*  has  been  termed  Methodism  (medically 
and  literally  speaking)  and  which  recognized  as  its 
founders  ^sculapius  and  Themison.  The  believers  in  tliis 
doctrine  attempted  to  apply  the  atomic  theory  of  Democ- 


14  THE    HISTORY    OF    MEDICINE. 

ritus  and  Epicurus  to  the  theory  and  practice  of  medicine. 
Atoms  of  various  size  were  supposed  to  pass  and  repass 
without  cessation  through  cavities  or  pores  in  the  human 
body.  So  long  as  the  atoms  and  pores  maintained  a  nor- 
mal relationship  of  size  and  proportion  health  was  main- 
tained, but  it  was  deranged  so  soon  as  the  exactness  ol' 
tliese  relations  was  destroyed  or  interfered  with.  The 
Dogmatists  considered  vital  reaction  as  a  primary  phenom- 
enon, \yhile  with  the  Methodists  it  was  secondary.  The 
Tliird  System  of  cosmogony,  founded  by  Parmenides  and 
Pyrrho,  believed  in  the  natural  improvement  of  bodies  in 
tlieir  endless  reproduction  and  change,  and  concluded  that 
wisdom  consisted  in  remaining  in  doubt ;  in  other  words, 
tliey  were  the  agnostics  of  that  day.  "AVhat  is  the  use," 
said  they,  "  of  fatiguing  the  mind  in  endeavoring  to  com- 
prehend wliat  is  beyond  its  capability "?  "  Later  they  were 
known  as  Skeptics  and  Zetetics,  to  indicate  that  they  were 
always  in  search  of  truth  without  flattering  themselves  that 
they  had  found  it.  To  them  corresponded  a  third  class  of 
physicians,  with  Philinus  and  Serapis  at  their  head,  who 
deemed  that  proximate  causes  and  primitive  phenomena  of 
disease  were  inaccessible  to  observation  ;  that  all  that  is 
affirmed  on  these  subjects  is  purely  hypothetical,  and  hence 
unworthy  of  consideration  in  choosing  treatment.  For 
tliem  objective  symptoms — or,  as  Ave  would  say,  signs — 
constituted  the  natural  history  of  disease,  they  thus  be- 
lieving that  their  remedies  could*. only  be  suggested  by  ex- 
perience, since  nothing  else  could  reveal  itself  to  them. 
Tliey  therefore  took  the  name  of  Empirics. 

Finally  a  fourth  class  of  physicians  'arose  who  would 
not  adopt  any  one  of  these  systems  exclusively,  but  cliose 
from  each  what  seemed  to  them  most  reasonable  and  satis- 
factory. They  called  themselves  Eclectics,  wishing  thereby 
to  imply  that  they  made  rational  choice  of  what  seemed 
best.  The  idea  conveyed  in  the  term  "eclecticism"  has 
been  fairly  criticised  for  this  reason :  eclecticism  is  in  reality 


PYTHAGORAS.  15 

neither  a  system  nor  a  theory ;  it  is  individual  pretension 
elevated  to  the  dignity  of  dogma.  The  true  eclectic  recog- 
,nizes  no  other  rule  than  his  particular  taste,  reason,  or  fancy, 
and  two  or  more  eclectics  have  Httle  or  nothing  in  common. 
If  that  were  true  two  thousand  years  ago,  it  is  not  much 
less  so  to-day.  The  eclectic  carefully  avoids  the  discussion 
of  principles,  and  has  neither  taste  nor  capacity  for  abstract 
reasoning,  although  he  may  be  a  good  practitioner;  not 
that  lie  has  no  ideas,  but  that  his  ideas  form  no  working 
system.  With  him  medical  tact — i.e.,  cultivated  instinct 
— replaces  principle. 

Tlie  eclectic  of  our  day,  however,  is  only  an  empiric  in 
disguise, — that  is,  a  man  w  hose  opinions  are  based  on  com- 
parison of  observed  facts,  but  whose  theoretical  ideas  do 
not  go  beyond  phenomena. 

In  older  days  philosophy  embraced  the  whole  of  human 
knowledge,  and  the  philosopher  was  not  permitted  to  be 
unacquainted  with  any  of  its  branches.  Now  physics, 
metaphysics,  natural  history,  etc.,  are  arranged  into  separate 
sciences,  and  the  sum-total  of  knowledge  is  too  great  to  be 
compassed  by  any  one  man. 

Pythagoras  was  the  last  of  the  Greek  sages  who  made 
use  of  hieroglyphic  writings  and  transmitted  his  doc- 
trine in  ancient  language.  Born  at  Samos,  he  was,  first; 
of  all,  an  athlete;  but  one  day,  hearing  a  lecture  on 
immortality  of  the  soul,  he  was  thereby  so  strongly 
attracted  to  philosophy  that  he  renounced  all  other 
occupation  to  devote  himself  to  it.  He  studied  arduously 
in  Egypt,  in  Phoenicia,  in  Chaldea,  and  even,  it  is  said,  in 
India,  where  he  was  initiated  into  the  secrets  of  the 
Brahmins  and  Magi.  Finally,  returning  to  his  own  country, 
he  was  received  by  the  tyrant  Polycrates,  but  not  made  to 
feel  at  home.  Starting  on  his  travels  again,  he  assisted  at 
one  of  the  Olympic  games,  and,  being  recognized,  was 
warmly  greeted.  He  sailed  to  the  south  of  Italy,  landed 
at  Crotona,  and  lodged  with  Milo,  the  athlete.     Commenc- 


16  THE    HISTORY    OF    MEDICINE. 

ing  here  his  lectures,  he  soon  gathered  around  him  a  great 
number  of  disciples,  of  whom  he  required  a  very  severe 
novitiate,  lasting  even  five  or  six  years,  during  which  they 
had  to  abstain  almost  entirely  from  conversation,  and  live 
upon  a  very  frugal  diet.  Those  only  who  persevered  were 
initiated  later  into  the  mysteries  of  the  order.  His  dis- 
ciples had  for  him  most  profound  veneration,  and  were 
accustomed  to  decide  all  disputes  with:  "The  master  has 
said  it."  Pythagoras  possessed  immense  knowledge;  he 
invented  the  theorem  of  the  square  of  the  hypothenuse,  and 
he  first  divided  the  year  into  365  days  and  6  hours.  He 
seems  to  have  suspected  the  movements  of  our  planetary 
system.  He  traveled  from  place  to  place,  and  founded 
schools  and  communities  wherever  he  went,  which  exer- 
cised, at  least  at  first,  only  the  happiest  influence;  but  tlie 
success  and  influence  which  their  learning  gave  them  later 
made  his  disciples  bold,  and  then  dishonest,  and  his  com- 
munities were  finally  dispersed  by  angry  mobs,  which 
forced  their  members  to  conceal  or  expatriate  themselves ; 
and  so,  even  during  the  life-time  of  its  founder,  the  Pytha- 
gorean Society  was  destroyed,  and  never  reconstructed. 

With  Pythagoras  and  his  disciples  numbers  played  a, 
very  important  role,  and  the  so-called  language  of  numbers 
was  first  taught  by  him.  He  considered  the  unit  as  the 
essential  principle  of  all  things,  and  designated  God  by  the 
figure  1  and  matter  by  the  figure  2,  and  then  he  expressed 
the  universe  by  12,  as  representing  the  juxtaposition  of  1 
and  2.  As  12  results  from  multiplying  3  by  4,  he  con- 
ceived the  universe  as  composed  of  three  distinct  worlds, 
each  of  which  was  developed  in  four  concentric  spheres, 
and  these  spheres  corresponded  to  the  primitive  elements 
of  fire,  air,  earth,  and  water.  The  application  of  the 
number  12  to  express  the  universe  Pythagoras  had  received 
from  the  Chaldeans  and  Egyptians — it  being  the  origin  of 
the  institution  of  the  zodiac.  Although  this  is  digressing, 
it  serves  to  show  what  enormous  importance  the  people  of 


THE    PYTHAGOREANS.  17 

that  time  attached  to  numbers,  especially  to  the  ternary 
and  quarternary  periods  in  the  determination  of  critical 
days  in  illness.  Pythagoras  was  the  founder  of  a  philo- 
sophic system  of  great  grandeur,  beauty,  and,  in  one  sense, 
completion,  embracing,  as  it  does,  and  uniting  by  common 
bounds  God,  the  universe,  time,  and  eternity ;  furnishing 
an  explanation  of  all  natural  phenomena,  which,  if  not 
true,  was  at  that  time  acceptable,  and  which  appears  in 
strong  and  favorable  contrast  as  against  the  mythological 
systems  of  pagan  priests.  No  wonder  that  it  captivated 
the  imagination  and  understanding  of  the  thinking  young- 
men  of  that  day.  Had  they  continued  in  the  original 
purity  of  life  and  thought  in  which  he  indoctrinated  them 
there  is  no  knowing  how  long  the  Pythagorean  school 
might  have  continued.  But  after  it  had  been  dissolved  by 
the  storm  of  persecution,  its  members  were  scattered  all 
over  Greece  and  even  beyond.  Now  no  longer  held  by 
any  bonds,  many  of  them  revealed  the  secrets  of  their 
doctrine,  to  which  circumstance  we  owe  the  little  knowl- 
edge thereof  we  now  possess. 

The  Pythagoreans  apparently  first  introduced  the 
custom  of  visiting  patients  in  their  own  homes,  and  they 
went  from  city  to  city  and  house  to  house  in  performance 
of  this  duty.  On  this  account  they  were  called  Periodic  or 
Ambulant  physicians,  in  opposition  to  the  Asclepiadae,  who 
prescribed  only  in  the  temples.  Empedocles,  of  Agrigen- 
tum,  well  known  in  the  history  of  philosophy,  was  perhaps 
the  most  famous  of  these  physicians.  Let  the  following- 
incident  witness  his  sagacity :  Pestilential  fevers  period- 
ically ravaged  his  native  city.  He  observed  that  their 
appearance  coincided  with  the  return  of  the  sirocco,  which 
blows  in  Sicily  on  its  western  side.  He  therefore  advised 
to  close  by  a  wall,  as  by  a  dam,  the  narrow  gorge  from 
which  this  wind  blew  upon  Agrigentum.  His  advice  was 
followed  and  his  city  was  made  free  from  the  pestilence. 

Again,  the   inhabitants   of  Selinus  were    ravaged    by 


18  THE    HISTORY   OF   MEDICINE. 

epidemic  disease.  A  sluggisli  stream  filled  the  city  with 
stagnant  water  from  whicli  mephitic  vapors  arose.  Em- 
pedocles  caused  two  small  rivulets  to  be  conducted  into  it, 
whicli  made  its  current  more  rapid ;  the  noxious  vapors 
dispersed  and  the  scourge  subsided. 

The  Gymnasia. — Before  we  proceed  to  a  somewhat 
more  detailed,  but  brief,  account  of  Hippocrates,  it  is  nec- 
essary to  say  a  word  or  two  of  the  ancient  gymnasia  of 
Greece,  which  were  used  long  before  the  Asclepiadce  had 
practiced  or  begun  to  teach.  In  these  gymnasia  were  three 
orders  of  physicians :  first,  the  director,  called  the  Gym- 
nasiarch ;  second,  the  subdirector,  or  Gijmnast,  who 
directed  the  pharmaceutical  treatment  of  the  sick;  and, 
lastly,  the  latrollptes,  who  i)ut  up  prescriptions,  anointed, 
bled,  gave  massage,  dressed  wounds  and  ulcers,  reduced 
dislocations,  treated  abscesses,  etc.  Of  the  gymnasiarchs 
wonderful  stories  are  told  evincing  their  sagacity,  which, 
though  somewhat  fabulous,  indicate  the  possession  of  a 
very  high  degree  of  skill  of  a  certain  kind.  Of  one  of  the 
most  celebrated  of  these,  Herodicus,  we  may  recall  Plato's 
accusation,  who  reprimanded  him  severely  for  succeeding 
too  well  in  prolonging  the  lives  of  the  aged.  Whatever 
else  may  be  said,  we  must  acknowledge  that  above  all 
others  the  Greeks  recognized  tlie  value  of  physical  culture 
in  the  prevention  of  infirmity,  and  of  all  physical  methods 
in  the  treatment  of  disease.  By  their  wise  enactments 
with  reference  to  these  matters  they  set  an  example  which 
modern  legislators  have  rarely,  if  ever,  been  wise  enough 
to  follow, — an  example  of  compulsory  physical  training  for 
the  young, — and  thereby  built  up  a  nation  of  athletes  and 
a  people  of  rugged  constitution  among  wliom  disease  was 
almost  unknown. 

I  come  now  to  the  so-called  Philosophic  Period,  or  the 
third  period  in  the  Age  of  Foundation,  which  is  insepar- 
ably connected  with  the  name  of  Hippocrates.  This  central 
figure  in  the  history  of  ancient  medicine  was  born  on  the 


HIPPOCRATES. 


19 


Island  of  Cos,  of  a  family  in  which  the  practice  of  medi- 
cine was  hereditary,  who  traced  their  ancestors  on  the  male 
side  to  ^sculapius,  and  on  the  female  side  to  Hercules. 
The  individual  to  wliom  every  one  refers  under  this  name 
was  the  second  of  seven ;  the  date  of  his  hirth  goes  back 
to  460  B.C.,  but  of  his  life  and  his  age  at  death  we  know 
little ;  it  is  supposed  generally  that  he  died  B.C.  377,  at  the 
age  of  83.     It  is  certain  that  he  traveled  widely,  since  his 


Fig.  3,— Hipi'OCKates. 


writings  evince  the  knowledge  tlius  gained.  He  was  a 
contemporary  of  Socrates,  although  somewhat  younger, 
and  lived  in  the  age  of  Pericles, — the  golden  age  for 
science  and  art  in  Greece. 

'J'he  Island  of  Cos  is  now  called  Stan-Co,  and  is  situated 
not  far  from  the  coast  of  Ionia.  Formerly  it  was  consid- 
ered as  having  a  most  salubrious  climate ;  now  that  it  is 
under  the  dominion  of  the  Turks,  it  is  considered  most 
unhealthy.     It  possessed  a  temple  dedicated  to  .^sculapius 


20  THE    HISTORY    OF    MEDICINE. 

and  a  celebrated  medical  school.  But  Hippocrates,  not 
satisfied  with  what  lie  could  learn  here,  visited  tlie  principal 
foreign  cities,  and  seems  to  have  been  a  most  accurate  and 
painstaking  observer  and  collector  of  notes.  That  he 
achieved  great  renown  in  his  life  is  known,  since  Plato  and 
even  Aristotle  refer  to  him  as  their  authority  in  very  many 
matters.  His  children  and  grandchildren  followed  in  his 
footsteps,  and  publislied  their  writings  under  the  same 
name;  it  has,  therefore,  beeome  difficult  to  distinguish  his 
works  from  theirs.  Finally,  authors  more  unscrupulous, 
who  bore  no  relationship  to  him,  attached  his  name  to 
their  own  writings.  But  the  true  were,  as  a  rule,  easily 
distinguished  from  the  spurious,  and  were  carefully  sepa- 
rated by  those  in  charge  of  the  Alexandrian  library. 

The  enumeration  of  his  writings  by  different  authors 
varies  very  much.  Renouard,  who  seems  to  have  studied 
the  subject  very  carefully,  gives  the  following  as  appearing 
to  him  to  be  the  authentic  list  of  writings  of  Hippocrates 
the  Second, — i.e.,  the  Great:  The  Prognostic^  the  Apho- 
risms^ the  first  and  third  books  of  Epidemics,  that  on 
Regimen  in  Acute  Disease,  that  on  Airs,Waiers,  and  Places, 
that  on  Articulations  and  Luxations,  that  on  Fractures,  and 
the  Mochlic,  or  the  treatise  on  instruments  and  reduction. 
This  list  does  not  comprise  the  fourth  part  oT  the  entire 
Hippocratic  collection,  but  its  authenticity  appears  to  be 
undoubted,  and  it  suffices,  as  Renouard  says,  to  justify  the 
enthusiasm  of  his  contemporaries  and  the  admiration  of 
posterity.  liater,  joined  with  the  writings  of  Pythagoras, 
Plato,  Aristotle,  and  others,  they  constituted  the  so-called 
Hippocratic  collection,  which  was  a  definite  part  of  the  great 
libraries  of  Alexandria  and  Pergamos,  and  formed  tlie  most 
ancient  authentic  monument  of  medical  science. 

Respect  for  the  bodies  of  the  dead  was  a  religious  ol)- 
servance  in  all  Greece,  and  prevented  the  dissection  of  the 
human  body.  Consequently  the  knowledge  of  anatomy 
possessed  by  Hippocrates  must  have  been  meagre.     Never- 


THE    HIPPOCKATIC    WRITINGS.  21 

theless,  he  described  lesions,  like  wounds  of  the  head,  of  the 
heart,  the  glands,  the  nature  of  bones,  etc.  It  being  im- 
possible to  establish  a  physiology  without  an  anatomical 
basis,  it  is  not  strange  that  we  iind  but  little  physiology  in 
the  Hippocratic  writings,  and  that  this  little  is  very  crude 
and  incorrect.  Arteries  and  veins  were  confounded,  and 
nerves,  tendons,  ligaments,  and  membranes  were  repre- 
sented as  analogous  or  interchangeable  tissues.  The 
physiologists  of  those  days  abandoned  tliemselves  to  tran- 
scendental speculation  concerning  the  nature  and  principles 
of  life,  whicli  some  placed  in  moisture,  others  in  fire,  etc. 
Speculation,  thus  run  wild,  prevented  such  accurate  obser- 
vation as  might  have  greatly  enhanced  the  progress  of 
pliysiological  knowledge. 

Hippocrates  wrote  at  least  three  treatises  concerning 
hygiene:  The  first,  on  Airs,  Waters,  and  Places^  the 
second,  on  Regimen  j  the  third,  on  Salubrious  Diet, — 
practically  an  abridgement  of  the  preceding,  in  which  he 
recommends  the  habit  of  taking  one  or  two  vomits  sys- 
tematically every  month.  The  classification  of  diseases 
into  internal  or  medical,  and  external  or  surgical,  is  not 
modern,  but  is  due  to  Hippocrates  ;  neither  is  it  philosophic, 
although  it  is  very  convenient. 

With  so  little  knowledge  of  physiology  and  pathology 
as  the  ancients  had,  it  is  not  strange  that  they  ascribed 
undue  importance  to  external  appearance;  in  other  words, 
to  wliat  has  been  termed  semeiotics,  which  occupies  a  very 
considerable  place  in  the  medical  treatises  of  the  Asclep- 
iadse.  Indeed,  tlie  writings  on  this  subject  constitute 
more  than  one-eighth  part  of  the  entire  Hippocratic  col- 
lection. To  prognosis,  also,  Hippocrates  ascribed  very 
great  importance,  saying  that  "  The  best  physician  is  tlie 
one  who  is  able  to  establisli  a  prognosis,  penetrating  and 
exposing  first  of  all,  at  the  bedside,  the  present,  the  past, 
and  the  future  of  his  patients,  and  adding  what  they  omit 
in  their  statements.     He  gains  their  confidence,  and  being 


22  THE    HISTORY    OF    MEDICINE. 

convinced  of  his  superiority  of  knowledge  they  do  not 
hesitate  to  commit  themselves  entirely  into  his  hands. 
He  can  treat,  also,  so  much  better  their  present  condition 
in  proportion  as  he  shall  be  able  from  it  to  foresee  the 
future,"  etc. 

To  the  careful  scrutiny  of  facial  appearances,  the  posi- 
tion, and  other  body-marks  about  the  patient  he  attributed 
very  great  importance ;  in  fact,  so  positive  was  he  about 
these  matters  that  he  embodied  the  princijial  rules  of 
semeiotics  into  aphorisms,  to  which,  however,  there  came 
later  so  many  exceptions  that  they  lost  much  of  their 
value.  From  certain  passages  in  his  book  on  Prediction^ 
and  from  the  book  on  Treatment,  which  is  a  part  of  the 
Hippocratic  collection,  it  appears  tliat  it  was  the  custom 
then  of  physicians  to  announce  the  probable  issue  of  the 
disease  upon  the  first  or  second  visit, — a  custom  which  still 
prevails  in  China  and  in  Turkey.  It  gave  the  medical 
man  the  dignity  of  an  oracle  when  right,  but  left  him  in  a 
very  awkward  position  when  wrong. 

To  Hipi)ocrates  we  are  indebted  for  the  classification 
of  sporadic,  epidemic,  and  endemic  forms,  as  well  as  for  the 
division  of  disease  into  acute  and  chronic.  Hippocrates 
wrote  extensively  on  internal  disease,  including  some  par- 
ticular forms  of  it,  such  as  epilepsy,  which  was  called  the 
sacred  disease ;  also  fragments  on  diseases  of  girls,  relat- 
ing particularly  to  hysteria;  also  a  book  on  the  nature  of 
woman,  an  extensive  treatise  on  diseases  of  women,  and  a 
monograph  on  sterility.  That  Hippocrates  was  a  remark- 
ably close  observer  of  disease  as  it  appeared  to  him  liis 
books  amply  prove ;  in  fact,  they  almost  make  one  think 
that  close  observation  is  one  of  the  lost  arts,  being  only 
open  to  the  objection  that  too  much  weight  was  attached 
to  insignificant  external  appearances,  speculation  on  which 
detracted  from  consideration  of  the  serious  feature  of  the 
case.  His  therapeutics,  considering  the  crude  information 
of  the  time,  was  a  vast  improvement  on  that  which  had 


THE    HIPPOCRATIC    WRITINGS.  23 

preceded,  and  really  entitled  bim  to  his  title  of  "Great 
Physician." 

Of  external  diseases  and  their  surgical  therapeutics  he 
wrote  fully:  on  The  Laboratory  of  the  Sur^eon^  dealing 
with  dressings,  bandaging,  and  operating ;  on  Fractures  ; 
and  on  Articulations  and  Dislocations ;  showing  much 
more  anatomical  knowledge  than  was  possessed  by  his  con- 
temporaries. Tlie  Mochlic  was  an  abridgment  of  former 
treatises;  in  Wounds  of  the  Head  he  formulated  the  dictum 
concerning  the  possible  danger  of  trifling  wounds  and  the 
possible  recovery  from  those  most  serious,  so  often  ascribed 
to  Sir  Astley  Cooper.  Other  monographs,  also,  he  wrote, 
on  Diseases  of  the  Eye^  on  Fistula^  and  on  Haemorrhoids. 
He  described  only  a  small  number  of  operations,  however, 
and  all  the  Hippocratic  writings  on  surgery  would  make 
but  a  very  incomplete  treatise  as  compared  with  those  that 
belong  to  the  next  historical  epoch  ;  all  of  which  we  have 
to  ascribe — in  the  main — to  prejudice  against  dissection 
and  ignorance  of  anatomy. 

From  the  earliest  times  pliysicians  and  writers  occupied 
themselves  largely  with  obstetrics,  as  was  most  natural. 
The  Hippocratic  collection  includes  monographs  on  Gen- 
eration ;  the  Nature  of  the  Infant  ;  the  Seventh  Month  of 
Pregnancy ;  the  Eighth  Month  of  Pregnancy ;  on  Accouche- 
mefit ;  on  Super foetatian  ;  on  Dentition  ;  on  Diseases  of 
Women  ;  on  Extraction  of  the  Dead  Foetus.  The  treatise 
on  superfcetation  concerned  itself  mainly  with  obstetrics. 

On  epidemics  Hippocrates  writes  extensively,  showing 
that  he  liad  studied  them  carefully.  He  was  among  the 
first  to  connect  meteorological  phenomena  with  those  of 
disease  during  given  seasons  of  the  year,  expressing  the 
hope  that  by  the  study  of  storms  it  would  be  possible  to 
foresee  the  advent  of  the  latter,  and  prepare  for  them. 
Seven  books  of  the  Hippocratic  collection  bear  the  title 
of  Epidemics,  although  only  two  of  them  are  exclusively 
devoted  to  this  subject.     In  these  books  were  contained  a 


24  THE   HISTORY   OF   MEDICINE. 

long  list  of  clinical  observations  relating  to  various  diseases. 
They  constituted  really  a  clinical  study  of  disease. 

The  collection  of  Hippocrates's  Aphorisms  fills  seven  of 
the  books ;  no  medical  work  of  antiquity  can  compare  with 
these.  Physicians  and  philosophers  of  many  centuries  have 
professed  for  them  the  same  veneration  as  the  Pythagoreans 
manifested  for  their  golden  verses.  They  were  considered 
the  crowning  glory  of  the  collection.  Even  within  a  short 
time  past  the  Faculty  of  Paris  required  aspirants  for  the 
medical  degree  to  insert  a  certain  number  of  these  in  their 
theses,  and  only  the  political  revolution  of  France  served 
to  cause  a  discontinuance  of  this  custom.  These  aphorisms 
formed,  says  Littre,  "a  succession  of  propositions  in  jux- 
taposition, but  not  united."  It  has  always  been  and 
always  will  be  disadvantageous  for  a  work  to  be  written  in 
that  style,  since  such  aphorisms  lose  all  their  general  sig- 
nificance ;  and  that  which  seems  isolated  in  itself  becomes 
more  so  when  introduced  into  modern  science,  with  wliich 
it  has  but  little  practical  relationship.  But  not  so  if  the 
mind  conceive  of  the  ideas  which  prevailed  when  these 
apliorisms  were  written  ;  in  this  liglit,  when  they  seem  most 
disjoined  they  are  most  related  to  a  common  doctrine  by 
which  they  are  united,  and  in  this  view  they  no  longer 
api^ear  as  detached  sentences. 

The  school  of  the  Asclepiadae  has  been  responsible  for 
certain  theories  which  have  been  more  or  less  prominent 
during  the  earlier  historical  days.  One  of  these  which 
prevailed  throughout  the  Hippocratic  works  is  that  of 
Coctlon  and  Crisis.  By  the  former  term  is  meant  thick- 
ening or  elaboration  of  the  humors  in  the  body,  w  Inch  was 
supposed  to  be  necessary  for  their  elimination  in  some 
tangible  form.  Disease  was  regarded  as  an  association  of 
phenomena  resulting  from  efforts  made  by  the  conservative 
principles  of  life  to  effect  a  coction, — i.e.,  a  combination  of 
the  morbific  matter  in  the  economy,  it  being  held  that  the 
latter  could  not  be  properly  expelled  until  thus  united  and 


THE   HIPPOCRATIC    DOCTRINES.  25 

prepared  so  as  to  form  excrementitioiis  material.  Tliis 
elaboration  was  supposed  to  be  brought  about  by  the  vital 
principles,  which  some  called  nature  (Physls),  some  spirit 
{Psyche),  some  breath  (Pneuma),  and  some  heat  {llter- 
mon).  The  gradual  climax  of  morbid  phenomena  has, 
since  the  days  of  Hippocrates,  been  commonly  known 
as  Crisis ;  it  was  regarded  as  the  announcement  of  the 
completion  of  the  union  by  coction.  Tlie  day  on  which  it 
was  accomplislied  was  termed  critical^  as  were  also  the 
signs  which  preceded  or  accompanied  it,  and  for  the  crisis 
the  physician  anxiously  watched.  Coction  liaving  been 
effected  and  crisis  occurring,  it  only  remained  to  evacuate 
the  morbific  material — which  nature  sometimes  spontane- 
ously accomplished  by  the  critical  sweat,  luination,  or 
stools,  or  sometimes  the  pliysician  had  to  come  to  her 
relief  by  the  administration  of  diuretics,  purgatives,  etc. 
The  term  "  critical  period "  was  given  to  the  number  of 
days  necessary  for  coction,  which  in  its  perfection  was  sup- 
posed to  be  four,  the  so-called  quarternary,  while  the  sep- 
tenary was  also  held  in  high  consideration.  Combination 
of  figures  after  the  Pythagorean  fashion  produced  many 
complicated  periods,  however,  and  so  periods  of  34,  40, 
and  60  days  were  common.  This  doctrine  of  crisis  in 
disease  left  an  impress  upon  the  medical  mind  not  yet 
fully  eliminated.  Celsus  was  the  most  illustrious  of  its 
adherents,  but  it  can  be  recognized  plainly  in  the  teach- 
ings of  Galen,  Sydenham,  Stahl,  Van  Swieten,  and  many 
others.  In  explanation,  it  must  be  said  that  there  have 
always  existed  diseases  of  nearly  constant  periods,  these 
being  nearly  all  of  the  infectious  form,  and  that  the  whole 
"critical"  doctrine  is  founded  upon  the  recognition  of  this 
natural  phenomenon. 

The  Hippocratic  books  are  full,  also,  of  the  four  ele- 
ments,— earth,  water,  air,  and  fire  ;  four  elementary  quali- 
ties,— namely,  heat,  cold,  dryness,  and  moisture ;  and  tlie 
four  cardinal  humors, — blood,  bile,  atrabile,  and  phlegm. 


26  THE    HISTORY   OF    MEDICINE. 

Owing  to  the  poverty  of  knowledge  of  physics  and 
chemistry  possessed  by  the  ancients,  and  notwithstanding 
their  errors  and  imperfections,  the  doctrine  of  Dogmatism, 
founded  upon  the  theory  of  coction  and  humors,  was  the 
most  intelligible  and  complete  among  the  medical  doctrines 
of  antiquity,  responding  better,  as  it  did,  to  the  demands 
of  the  science  of  that  day.  That  Hippocrates  was  a  pro- 
found observer  is  shown  in  this :  that  he  reminds  both 
philosophers  and  physicians  that  the  nature  of  man  cannot 
be  well  known  without  the  aid  of  medical  observation,  and 
that  nothing  should  be  affirmed  concerning  that  nature 
until  by  our  senses  we  have  become  certain  of  it.  In  tliis 
maxim  he  took  position  opposed  to  the  Pythagorean  doc- 
trine, and  included  therein  the  germ  of  a  new  philosophy 
of  which  Plato  misconceived,  and  of  which  Aristotle  had  a 
very  faint  glimpse. 

Another  prominent  theory  throughout  the  Hippocratic 
books  is  that  of  Fluxions,  meaning  thereby  about  what  we 
would  call  congestions,  or  conditions  which  we  would  say 
were  ordinarily  caused  by  cold,  though  certain  fluxions  were 
supposed  to  be  caused  by  heat,  because  the  tissues  thereby 
became  rarefied,  their  pores  enlarged,  and  their  humor 
attenuated  so  that  it  flowed  easily  when  compressed.  The 
whole  theorv  of  fluxion  was  founded  on  the  densest  ijjnor- 
ance  of  tissues  and  the  laws  of  physics,  the  body  of  man 
being  sometimes  likened  to  a  sponge  and  sometimes  to  a 
sieve.  The  treatment  recommended  was  almost  as  crazy  as 
the  theory.  Certain  other  theories  have  complicated  or 
disfigured  the  Hippocratic  writings,  and  certain  have  been 
founded  on  the  consideration  of  two  elements — i.e.,  fire 
and  earth— or  on  the  consideration  of  one  single  element 
which  was  supposed  to  be  air, — the  breath,  or  pneuma  ; 
and  tixore  was — lastly — the  theory  of  any  excedeiii,  which 
is  very  vague;  of  all  of  these  we  may  say  that  they 
are  not  of  sufficient  interest  to  demand  expenditure  of 
our  time. 


HIPPOCRATES'S   FOLLOWERS.  27 

The  eclat  which  the  second  (i.e.,  the  Great)  Hippocrates 
gave  to  the  school  of  Asclepiadae  in  the  Island  of  Cos  long 
survived,  and  many  members  of  his  family  followed  in  his 
footsteps.  Among  his  most  prominent  successors  were 
Polybius,  Diodes,  and  Praxagoras,  also  of  Cos, — the  last 
of  the  Asclepiadae  mentioned  in  history.  Praxagoras  was 
distinguished  principally  for  his  anatomical  knowledge ; 
like  Aristotle,  he  supposed  that  the  veins  originated  from 
the  heart,  but  did  not  confound  these  vessels  with  the 
arteries,  as  his  predecessors  had  done,  but  supposed  that 
they  contained  only  air,  or  the  vital  spirit.  It  has  been 
claimed  that  he  dissected  the  human  body.  He  laid  the 
foundation  of  sphygmology,  or  study  of  the  pulse,  since 
Hippocratic  writers  rarely  alluded  to  arterial  pulsations 
and  described  them  as  of  only  secondary  importance. 

The  predominating  theory  in  the  Island  of  Cos  was 
that  which  made  health  dependent  on  the  exact  proportion 
and  play  of  the  elements  of  the  body,  and  on  perfect  com- 
bination of  the  four  cardinal  humors.  This  was  the 
prevailing  doctrine, — i.e.,  the  Ancient  Medical  Dogmatism, 
so  named  because  it  embraced  the  most  profound  dogmas 
in  medicine,  and  was  taught  exclusively  until  the  founda- 
tion of  the  school  at  Alexandria, 

Two  men,  however,  more  commonly  ranked  among 
philosophers  than  among  physicians  of  antiquity,  dissected 
the  statements  of  Hippocrates,  and  embodied  them  more 
or  less  in  their  own  teachings,  and  thus  exercised  a  great 
influence  on  tlie  progress  of  the  hurhan  mind,  particularly 
in  the  direction  of  medical  study.  The  first  of  these  wai- 
Plato,  profound  moralist,  eloquent  writer,  and  most  versa- 
tile thinker  of  his  day  or  any  other.  He  undertook  the 
study  of  disease,  not  by  observation  (the  empirical  or 
experimental  method),  but  by  pure  intuition.  He  seemed 
to  have  never  discovered  that  his  meditations  were  taken 
in  the  wrong  direction,  and  that  the  method  did  not  con- 
duce to  the  discovery  of  abstract  truths.      He  gave  beauty 


28  THE   HISTORY    OF    MEDICINE. 

an  abstract  existence,  and  affirmed  that  all  things  beautiful 
are  beautiful  because  of  the  presence  of  beauty.  This 
reminds  one  of  that  famous  response  in  the  school  of  the 
Middle  Ages  to  a  question  :  "  Why  does  opium  produce 
sleep?"  the  answer  Ijeing:  "  Because  it  possesses  the  sleepy 
principle."  Plato  introduced  into  natural  science  a  doctrine 
of  final  causes.  He  borrowed  from  Pythagoras  the  dogma 
of  homogeneity  of  matter,  and  claimed  that  it  liad  a 
triangular  form. 

Aristotle,  equally  great  thinker  as  Plato,  but  whose  men- 
tal activity  was  manil'est  in  other  channels,  was  born  B.C. 
384,  in  Stcigyria,  in  Macedonia.  He  was  fascinated  by  the 
teachings  of  Plato,  and  attained  such  eminence  as  a  student 
that  King  Philip  of  Macedon  made  him  preceptor  to  his 
son  Alexander,  subsequently  the  Great,  by  whom  he  was 
later  furnished  with  sufficient  funds  to  form  the  first  known 
museum  in  natural  history, — a  collection  of  rare  objects  of 
every  sort,  transmitted,  many  of  them,  by  the  royal  hands 
of  his  former  student  from  the  remote  depths  of  Asia. 
Aristotle,  by  long  odds  the  greatest  naturalist  of  antiquity, 
laid  the  first  philosophic  basis  for  empiricism.  He  admitted 
four  elements — fire,  air,  earth,  and  water — and  believed 
them  susceptible  of  mutual  transmutation.  He  studied  the 
nature  of  the  soul  and  that  of  the  animal  body;  regarded 
heat  and  moisture  as  two  conditions  indispensable  to  life ; 
described  the  brain  with  some  accuracy,  but  without  the 
least  idea  of  its  true  function ;  said  that  the  nerves  pro- 
ceeded from  the  heart ;  termed  the  aorta  a  nervous  vein  ; 
and  made  various  other  mistakes  which  to  us  seem  inex- 
cusable. Nevertheless,  he  was  rich  in  many  merits,  and  no 
one  of  his  age  studied  or  searched  more  things  than  he, 
nor  introduced  so  many  new  facts.  Although  he  never 
dissected  human  bodies,  he  nevertheless  corrected  errors  in 
anatomy  held  to  by  the  Hippocratic  scliool.  He  dissected 
a  large  number  of  animals  of  every  species,  and  noted  tlie 
varieties  of  size  and  shape  of  hearts  of  various  animals  and 


ARISTOTLE.  29 

birds.  In  other  words,  he  created  a  comparative  anatomy 
and  physiology,  and  the  plan  that  he  traced  was  so  com- 
plete that  two  thousand  years  later  the  great  French  natu- 
ralist Cuvier  followed  it  quite  closely.  If  he  be  charged 
with  having  propagated  a  taste  for  scholastic  subtleties,  he 
also  furnished  an  example  of  patient  and  attentive  observa- 
tion of  Nature.  His  history  of  animals  is  a  storehouse  of 
knowledge,  and  his  disciples  cultivated  with  zeal  anatomy, 
physiology,  and  natural  history.  His  successor,  Tlieo- 
phrastus,  was  the  most  eminent  botanist  of  antiquity. 

It  will  thus  be  seen  that  Plato  and  Aristotle  were  the 
eminent  propagators  of  two  antagonistic  opinions.  One 
supposed  knowledge  to  be  derived  by  mental  intuition,  and 
the  other  tliat  all  ideas  are  due  to  sensation.  Both  count 
among  moderns  some  partisans  of  the  greatest  acumen: 
Descartes,  Leibnitz,  and  Kant  being  followers  of  Plato, 
and  Bacon,  Locke,  Hume,  and  Condillac,  of  Aristotle. 

The  excuse  for  stating  these  things,  which  appar- 
ently do  not  so  closely  concern  the  history  of  medicine, 
must  be  that  of  the  learned  interpreter  of  the  doctrine  of 
Cuvier,  tliat  "  The  first  question  in  science  is  always  a 
question  of  method." 

Hippocrates  formed  a  transition  between  a  period  of 
mythology  and  that  of  history.  His  doctrine  was  received 
by  contemporaries  and  by  posterity  with  a  veneration  akin 
to  worship.  No  other  man  ever  obtained  homage  so  ele- 
vated, constant,  and  universal.  A  little  later  ignorance 
reigned  in  the  school  that  he  made  celebrated.  Methods 
and  theories  were  propagated  there  under  the  shadow  of 
his  name  which  he  would  have  disowned. 

Medical  science  now  changes  its  habitation  as  \yell  as 
its  aspect,  and  from  the  record  of  Hippocrates  and  his 
work  we  turn  to  the  fourth  period  of  the  Age  of  Foun- 
dation,— namely,  the  Anatomic,  which  extends  from  the 
foundation  of  the  Alexandrian  library,  320  B.C.,  up  to  the 
death  of  Galen,  about  the  vear  a.d.  200. 


CHAPTER  II. 

Age  of  Fouxdatiox  [confitmed). — Aiiatmnic  Period :  lufluence  of  the  Alexan- 
drian Library.  Herophilus  and  Erasistratus.  Celsus,  A.D.  f  50  (?). 
Aretseus,  t  a.d.  90.  Galen,  131-201. — Empirici»m  :  Asclepiades,  B.C.  128- 
56.     Methodism:  Themisou,  B.C.  50  (?). — Ededieimi. 

Age  of  Traxsition,  a.d.  201-1400.— Greet  Period:  Oriljasius,  326-403. 
JEtins,  502-575.  Alexander  of  Tralles,  525-605.  Pauliis  .Egineta, 
625-690. 

Fourth,  or  Anatomic,  Period.  —  As  already  seen, 
Alexander  the  Great  and  his  successors  collected  tlie  in- 
tellectual and  natural  riches  of  the  universe,  as  they  knew 
them,  and  placed  them  at  the  disposal  of  studious  men  to 
benefit  humanity ;  tlieir  complete  value  has  not  yet  been 
exhausted,  and  never  can  be.  This  undertaking  was 
carried  out  under  conditions  that  made  it  one  of  extreme 
difficulty.  Manuscripts  were  then  rare  and  most  costly ; 
but  few  copies  of  a  given  work  were  in  existence,  often 
only  one,  and  these  were  held  almost  priceless.  Under 
these  circumstances  the  establishment  of  a  public  library 
and  of  a  museum  was  an  act  of  philanthropy  and  liberality 
simply  beyond  eulogy,  and  did  more  to  immortalize  the 
founder  of  the  collection  than  all  his  victories  and  other 
achievements. 

This  appears  to  have  also  occurred  to  two  of  Alexander's 
lieutenants — one  Eumenes,  Governor  of  Pergamos,  and  the 
other,  Ptolemy,  Governor  of  Egypt.  After  the  death  of 
the  conqueror  his  generals  shook  of  all  dependence  upon 
the  central  government,  and  endeavored  to  centralize  their 
own  authority.  But  these  two  were  the  only  ones  among 
so  many  leaders  who  did  not  devote  all  their  attention  to 
armies  and  invasion,  but  interested  themselves  in  commerce 
and  arts.  So  active  were  they  in  the  enterprise  that 
Eumenes  had  gathered  two  hundred  thousand  volumes  for 
the  library  at  Pergamos,  and  Ptolemy  six  to  seven  hun- 
dred thousand  for  that  of  Alexandria.  The  latter  was 
(30) 


THE    ALEXANDRIAN    SCHOOL.  31 

divided  into  two  parts,  the  greater  and  the  lesser,  the  latter 
of  wliich  was  kept  in  the  temple  of  Serapis,  hence  known 
as  the  Serapium.  These  notable  efforts  to  found  enor- 
mous collections  first  excited  praiseworthy  rivalry  among 
contemporaries  and  rulers,  which,  however,  degenerated 
into  contemptible  jealousy,  so  that  some  of  the  rulers  of 
Alexandria  even  went  so  far  as  to  interdict  the  exportation 
of  pa])yrus,  in  order  to  prevent  the  making  of  copies  for  the 
library  of  Pergamos.  But  tlie  effect  was  unexpected,  since 
it  led  to  the  invention  of  the  paper  of  Pergamos,  otherwise 
called  parchment,  which  completely  displaced  the  pith 
from  which  papyri  were  made.  Be  this  as  it  was,  the  col- 
lection at  Alexandria  had  a  much  more  marked  influence 
on  the  medical  study  of  the  future  than  that  of  Pergamos, 
and  calls  for  our  particular  notice.  About  it  sprang  up 
first  a  collection  of  learned  men,  and  then  the  inevitable 
result — a  school  of  learning.  It  was  Ptolemy  Soter  who 
called  around  him  the  most  renowned  men  of  his  day.  He 
])rovided  them  with  homes  adjoining  the  library,  endowed 
them  with  salaries,  and  charged  them  with  the  classification 
and  collation  of  manuscripts,  or  with  the  giving  of  instruc- 
tion by  lectures  and  discussions.  Ptolemy  himself  some- 
times took  part  in  these  feasts  of  reason,  which  became 
still  more  frequent  and  formal  under  his  son  Ptolemy 
Philadelphus.  These  were  called  the  Feasts  of  the  Muses 
and  of  Apollo, — i.e.,  ludi  musarum., — and,  consequently, 
the  place  where  they  were  held  came  to  be  termed  the 
"  museum.'^  Often  the  subjects  for  discussion  were  an- 
nounced in  advance,  and  those  who  gained  the  most 
applause  received  rewards  in  accordance  with  the  merits 
of  their  work.  Among  those  who  enjoyed  these  advan- 
tages under  the  reign  of  these  two  Ptolemies  are  promi- 
nently named  two  physicians,  Herophilus  and  Erasistratus, 
the  latter  said  to  be  the  grandson  of  Aristotle.  It  was 
under  this  Philadelphus  that  the  Hebrew  wise  men  trans- 
lated into  Greek  the  Holy  Scriptures,  which  translation 


32  THE   HISTORY    OF   MEDICINE. 

has  since  been  called  the  Septuagint — so  called  because  it 
is  supposed  to  have  been  translated  by  the  members  of  the 
Sanhedrim,  which  was  composed  of  about  seventy  men,  or 
because,  according  to  another  legend,  it  was  translated  by 
seventy-two  men  in  seventy-two  hours.  These  savants  of 
ancient  Egypt,  thus  supported  by  the  dynasty  of  the  Lagides, 
gave  the  first  place  to  the  science  of  medicine.  As  regards 
this  study,  the  school  of  Alexandria  eclipsed  almost  from 
its  origin  the  ancient  schools  of  Cos  and  Pergamos,  and 
during  its  existence  was  the  leading  institution  of  its  kind 
in  the  world.  At  the  time  of  Galen  it  was  sufficient  to 
have  studied  there,  and  even  to  have  resided  a  short  time 
in  Alexandria,  to  obtain  the  reputation  of  being  a  phy- 
sician. Nearly  all  the  scholars  of  these  five  centuries  had 
received  instruction  in  this  school.  The  principal  reason 
for  its  eminence  in  medical  instruction  was  the  practice  of 
dissection  of  human  bodies,  which,  under  tlie  Ptolemies,  was 
allowed  and  recommended,  and  by  which  the  science  of 
medicine  received  an  extraordinary  impulse.  Although 
the  prejudice  of  Egyptians  was  very  strong  against  those 
who  touched  a  dead  body,  the  Ptolemies  themselves  are 
said  to  have  participated  in  this  kind  of  anatomical  study, 
thus  destroying  by  their  example  the  odium  previously 
attached  to  dissection.  Strange  to  say,  however,  tlie  prac- 
tice of  dissection  fell  into  disuse  toward  the  end  of  this 
Anatomic  Period,  and  scholars  preferred  to  indulge  in 
subtle  metapliysical  discussions  rather  than  study  human 
tissues.  But  the  principal  reason  for  giving  up  this  prac- 
tice was  the  Roman  domination  of  Egypt,  the  Romans, 
inconsistently,  being  perfectly  willing  to  see  any  amount 
of  bloodshed  in  the  arena,  and  all  sorts  of  inluimanities 
practiced  upon  living  human  beings,  but  holding  that  con- 
tact with  a  corpse  was  profanation ;  so  that  not  a  single 
anatomist  of  reputation  had  his  origin  in  ancient  Rome. 
"If  on  any  occasion,"  says  Renouard,  "a  foreign  physician 
attached  to  the  king  or  general  desired  to  avail  himself  of 


HEROPHILUS.  33 

the  occasions  that  were  afforded  to  examme  the  structures 
of  the  internal  parts  of  the  human  body,  lie  was  obhged  to 
conceal  and  carry  off  during  the  night  some  body  aban- 
doned to  the  birds  of  prey."  To  complete  the  melancholy 
termination  of  the  Anatomic  Period,  the  labors  of  the 
writers  of  those  days  were  all  lost  by  the  burning  of  the 
greiit  library  by  Julius  Caesar,  which  was  the  beginning  of 
the  chain  of  disasters  with  which  Egypt  was  accursed 
under  Roman  dominion.  Although  Mark  Antony,  in- 
duced thereto  by  the  endearments  and  solicitations  of 
Cleopatra,  transported  the  library  of  Pergamos  to  Alex- 
andria, even  this  was  unavailing  to  restore  the  position  of 
the  school,  since  the  atrocious  and  imbecile  Caracalla  took 
from  the  pensioners  of  the  museum  their  privileges  of 
common  residence  and  every  other  advantage,  and  sup- 
pressed all  public  exhibitions  and  discussions.  I  can 
mention  but  few  of  the  names  most  eminent  during  this 
Anatomic  Period,  and  but  a  short  account  of  the  life  and 
work  of  each. 

The  first  deserving  of  mention  was  Herophilus,  who 
was  born  in  Chalcedon  about  the  end  of  the  fourth  century 
before  Christ,  and  supposed  to  be  the  first  to  undertake  sys- 
tematic dissection  of  the  human  body.  The  so-called  Tor- 
cular  Herophili,  or  common  meeting-place  of  the  sinuses  at 
the  occiput,  named  after  him,  gives  evidence  of  his  influ- 
ence upon  the  study  of  anatomy.  He  wrote  on  all  depart- 
ments of  medical  science,  concerning  the  eyes,  the  pulse, 
midwifery,  etc.,  as  well  as  numerous  commentaries  upon 
the  Hippocratic  writings, — describing  the  membranes  of 
the  brain  and  its  vessels,  the  choroid  plexus,  the  ventricles 
of  the  brain,  the  tunics  of  the  eye,  the  intestinal  canal,  and 
certain  portions  of  the  vascular  system.  He  alluded  to  the 
thoracic  duct  without  knowing  its  purpose,  and  gave  a 
more  accurate  description  of  the  genitalia  than  any  pre- 
vious writer.  Strange  to  say,  but  little  is  known  of  his 
later  life,  and  of  his  death  absolutely  nothing. 


34  THE    HISTORY    OF    MEDICINE. 

Erasistratus  was  the  son  of  Cleombrotus,  a  student  of 
Metiodorus,  and  lived  for  some  time  at  the  court  of  Seleu- 
cus  Nicator,  wliose  son,  Antioclius,  he  liealed  of  a  secret 
ailment,  wliich  happened  to  be  a  desperate  love-affair  with 
his  step-mother,  Stratonice.  He  wrote  extensively  on 
fevers,  hygiene,  paralyses,  therapeutics,  and  many  other 
subjects ;  regarded  most  diseases  as  due  to  overindulgence 
in  food,  wliich  is  not  digested,  and  consequently  putrefies. 
Plethora  was  for  him  the  prevailing  disease,  against  which 
he  employed  not  only  venesection,  but  fasting,  and  band- 
aijins:  of  the  extremities.  He  was  a  diligent  student  of 
anatomy,  and  carefully  described  the  brain  in  many  of  its 
grosser  features,  regarding  it  as  the  seat  of  the  soul  and  the 
centre  of  the  nerves.  He  also  described  more  exactly  than 
his  predecessors  the  valves  of  the  heart,  wliich  organ  he 
rejjfarded  as  the  ori«-in  of  veins  and  arteries.  He  discov- 
ered  the  lymph-vessels,  and  maintained,  against  Plato  and 
others,  that  the  epiglottis  prevents  the  entrance  of  fluids 
into  the  lungs,  but  he  supposed  digestion  to  be  produced 
by  mechanical  trituration  in  tlie  stomach,  and  preferred 
gymnastics,  exercise,  diet,  and  baths  to  drugs  or  other 
therapeutic  measures.     He  died  about  280  B.C. 

Cornelius  Celsus,  the  most  celebrated  author  for  a 
number  of  centuries,  was  born  in  Home  about  the  time  of 
Clirist.  Brilliant  as  he  was,  he  exerted  a  wide-spread 
influence  for  centuries.  The  exact  date  of  his  death  is 
unknown.  He  Was  a  contemporary  of  the  greatest  philos- 
ophers, poets,  and  savaiiis  of  Rome  during  its  most  brilliant 
period.  He  studied  rhetoric,  philosopliy,  the  art  of  war, 
econoniics,  and  medicine — he  was,  in  fact,  a  walking  ency- 
clopaedia of  the  knowledge  of  his  day;  but  it  is  in  medicine 
that  he  shows  to  best  advantage,  and  in  his  capacity  as  a 
physician  he  was  and  is  best  known.  The  direction  in 
which  Celsus  appears  to  least  advantage  is  in  failure  of 
power  of  direct  observation,  and  in  yielding  unquestioning 
obedience  to  the  views  and  dicta  of  Hippocrates,  for  whom 


CELSUS.  ?,0 

he  possessed  tlie  greatest  reverence,  not  being  able  to  brook 
any  serious  contradiction  or  opposition  to  his  opinions.  In 
this  reverence  for  Hippocratic  authority  he  was  followed  by 
many  less  })rominent  successors,  the  consequence  being  a 
failure  to  train  men  as  observers,  the  endeavor  being  to 
make  them  simply  storehouses  of  information  derived  from 
Hippocratic  writings.  As  a  result,  Celsus  wrote  but  little, 
or  else  his  writings  are  lost.     He  contented  himself  mostly 


Fig.  4.— Auli's  CoRNEi.irs  Celsus. 


with  a  mere  commentary  u])on  the  writings  which  he  so 
highly  revered.  But  little  of  his  writings  remain,  and 
these  pertain  mostly  to  the  therapeutics  of  curable  disease, 
dietetic,  pharmaceutical,  and  surgical.  Although  he  exer- 
cised great  authority  during  his  period,  he  was  later  totally 
supplanted  by  Galen,  and  liis  views  are  seldom  mentioned 
in  the  writings  of  those  subsequent  to  this  great  physician. 
His  death  must  have  taken  place  about  the  middle  of  the 
first  centurv  after  Christ. 


36  THE   HISTORY    OF   MEDICINE. 

Aretseus,  who  died  about  a.d.  90,  was  one  of  the  most 
brilHant  hghts  of  antiquity  previous  to  the  Christian  era, 
but,  in  spite  of  all  tliis,  of  his  life  very  little  is  known. 
He  came  from  Cappadocia  about  the  end  of  the  reign  of 
Nero,  and  lived  in  Alexandria.  That  he  lived  in  Alexandria 
is  apparent  from  his  numerous  references  to  its  location,  to 
the  habits  and  therapeutics  of  the  Egyptians,  and  to  the 
geography  of  the  country.  Furthermore,  references  to  its 
diseases  abound  in  his  writings,  so  that  it  is  made  to  appear 
that  he  had  had  the  best  advantages  there,  although  he 
must  have  traveled  extensively.  But  a  small  portion  of  his 
writings  remain,  and  these  consist,  for  the  most  part,  of 
compendiums  of  pathology  and  therapeutics.  He  described 
disease,  not  in  anatomical  order,  from  head  to  foot,  but 
under  the  classification  of  acute  and  chronic.  With  the 
exception  of  Hippocrates,  he  has  shown  himself  the  most 
free  from  vague,  arbitrary  speculation,  and  from  the  dog- 
matism of  the  schools  of  any  writer  of  antiquity.  He, 
more  than  any  other  up  to  his  time,  endeavored  to  found 
pathology  upon  a  sound  anatomical  basis.  For  every 
picture  of  disease  he  endeavored  to  provide  a  suitable 
anatomical  accompaniment.  This  appears  particularly,  for 
instance,  in  his  description  of  intestinal  ulcers  due  to  dys- 
entery, or  the  paralyses  following  brain  affections,  or  his 
description  of  pliaryngeal  diplitherias,  of  which  he  gave  a 
good  account  under  the  name  of  Syriac  or  Egyptian  ulcers. 
Pulmonary  tuberculosis,  tetanus,  and  anal  fistula  are  amply 
mentioned  in  his  writings.  His  therapeutics  were  simple 
and  rational ;  he  laid  great  stress  upon  dietetic  treatment. 
His  surgical  writings  appear  to  have  all  been  lost,  but 
there  is  every  reason  to  think  that  he  brought  to  bear 
upon  external  medicine  tlie  same  good  sense  which  he 
applied  to  internal  affections. 

Of  all  the  students  of  Hippocratic  dogmatism,  the  most 
skillful  and  learned  was  Claudius  Galen  (131-201),  a  native 
of   Pergamos,  a  place    already  celebrated    for    its  temple 


GALEN. 


37 


dedicated  to  ^sculapius,  for  its  school  of  medicine,  and  for 
a  library  which  had  been  removed  to  Alexandria.  He  was 
placed  by  his  father  under  the  most  disthiguislied  teachers 
in  all  of  the  sciences,  and  even  as  a  young  man  showed 
extraordinary  progress,  and  became  early  a  disputant  with 
the  most  erudite  in  grammar,  history,  mathematics,  and 
philosophy.     He  has  related  how  in  two  different  dreams 


Fig.  5.— The  Conversion  of  Galen. 

(From  an  old  engraving  puljlislied  by  R.  Sayer  &  J.  Bennett,  London,  1775.) 


he  was  urged  by  Apollo  to  study  medicine.  He  traveled 
widely  for  instruction,  and  remained  some  time  in  Alex- 
andria. On  his  return  to  his  own  country  he  was  charged 
by  its  ruler  to  dress  the  wounded  in  the  great  circus,  Avhich 
furni.shed  him  opportunity  for  displaying  all  his  anatomical 
knowledge  and  surgical  skill.  Not  remaining  long  at 
home,  he  went  to  Home,  where  his  renown  had  preceded 
him,  and  where,  by  his  brilliant  elocution,  his  accurate 


38  THE   HISTORY    OF    MEDICINE. 

logic,  and  his  profound  erudition,  as  well  as  his  versatility 
and  practical  skill,  he  at  once  took  tlie  highest  place.  But 
here  liis  rapid  success,  his  vanity,  his  disdain  for  his  col- 
leagues, and  his  useless  boasting,  as  well  as  his  natural 
jealousy,  gained  him  the  enmity  of  nearly  all  his  contem- 
poraries, and  his  stay  at  Rome  was  thereby  made  very 
disagreeable.  In  his  work  on  Prenotions  he  accuses 
his  colleagues  ol'  base  jealousy  and  stupid  ignorance, 
lavishes  upon  them  such  epithets  as  "  thieves  "  and  "  pois- 
oners," and  closes  by  saying  that  after  having  unmasked 
them  he  would  leave  tliem  to  their  evil  designs  by  abandon- 
ing the  great  city  to  seek  a  home  in  a  smaller  place,  where 
the  surroundings  would  be  to  him  more  congenial.  This 
threat  he  carried  out,  but  soon  returned  to  Rome  upon  the 
invitation  of  the  Emperors  Marcus  Aurelius  and  Lucius 
Verus,  whose  confidence,  as  well  as  that  of  tlieir  successors, 
he  enjoyed.  He  is  supposed  to  have  lived  to  the  age  of 
seventy-one,  and  to  have  died  about  201  a.d.  Galen 
strongly  denied  being  attached  to  any  of  the  sects  of 
his  day,  and  regarded  as  slaves  those  who  took  the  title 
of  Hippocratists,  Praxagoreans,  Herophilists,  and  so  on. 
Nevertheless,  his  predilection  in  favor  of  the  Hippocratic 
writings  is  well  marked,  for  he  explains,  comments  upon, 
and  expands  tliem  at  length,  refutes  the  objections  of 
their  adversaries,  and  gives  them  the  highest  place.  He 
says :  *'  No  one  before  me  has  given  the  true  method  of 
treating  disease;  Hippocrates,  I  confess,  has  heretofore 
shown  the  path,  but  as  he  was  the  first  to  enter  it  he  was 
not  able  to  go  as  far  as  he  wished.  .  .  .  He  has  not 
made  all  the  necessary  distinctions,  and  is  often  obscure,  as 
is  usually  the  case  with  ancients  when  they  attempt  to  be 
concise.  He  says  very  little  of  complicated  diseases;  in  a 
word,  he  has  only  sketched  what  another  was  to  complete ; 
he  has  opened  the  path,  but  has  left  it  for  a  successor  to 
enlarge  and  make  it  plain."  This  implies  how  he  regarded 
himself  as   the  successor  of  Hippocrates,  and    liow  little 


galen's  theories.  39 

weight  he  attached  to  tlie  hibors  of  others.  He  held  that 
tliere  were  three  sorts  of  principles  in  man  :  spirits,  humors, 
and  solids.  Throughout  liis  metapliysical  speculations 
Galen  reproduces  and  amphfies  the  Hippocratic  dogmatism. 
Between  perfect  health  and  disease  there  were,  he  thought, 
eight  kinds  of  temperaments  or  imperfect  mixtures  com- 
patible with  the  exercise  of  the  functions  of  life.  With 
Phito  and  Aristotle,  he  thought  the  human  soul  to  be  com- 
posed of  tliree  faculties  or  parts:  the  vegetative,  residing  in 
the  hver;  the  irascible,  having  its  seat  in  the  heart;  and 
the  rational,  which  resides  in  the  brain.  He  divided  dis- 
eases of  the  solids  of  the  body  into  what  lie  called  dis- 
tempers ;  he  distinguished  between  the  continued  and 
intermittent  fevers,  regardhig  tlie  quotidian  as  being  caused 
by  phlegm,  the  tertian  as  due  to  yellow  bile,  and  the  quartan 
as  due  to  atrabile.  In  the  doctrine  of  coction,  crises,  and 
critical  days  he  agreed  with  Hippocrates;  with  him  he 
also  agreed  in  the  positive  statement  that  diseases  are  cured 
by  their  contraries.  From  all  this  it  will  be  seen  that 
Galen  must  be  regarded  as  one  of  the  earliest  of  Hippoc- 
ratic dogmatists.  He  was  a  most  extensive  writer,  and  it 
is  said  that  the  total  number  of  his  works  exceeded  one 
hundred.  His  contributions  to  anatomy  were  not  insignifi- 
cant. For  myology  he  did  a  great  deal.  He  wrote  a 
monograph  on  the  skeleton  in  which  he  recommended  that 
bones  be  seen  and  handled,  not  merely  studied  from  books, 
and  that  the  student  should  go  to  Alexandria,  where 
teachers  would  place  before  him  the  real  human  skeleton. 
It  has  been  inferred  that  there  was  not,  in  his  time,  in 
Rome  a  single  skeleton.  He  wrote  fifteen  books  on 
anatomy,  of  which  six  are  lacking ;  also  an  extensive 
treatise  on  the  lesions  of  the  human  body,  distributed 
among  seventeen  books  which  have  come  down  to  us.  He 
is  supposed  to  have  introduced  the  term  "  symphysis,"  and 
he  described  nearly  every  bone  in  the  human  body.  By 
him  the  muscles  were  no  longer  considered  as  inert  masses 


40  THE   HISTORY   OF   MEDICINE. 

and  tissue-layers  serving  to  cover  the  bones,  but  he  classified 
them  according  to  their  distinct  functions,  and  studied  sep 
arately  their  form  and  uses.  The  location  of  the  vessels 
and  nerves  between  them  was  also  noted,  and  it  was  proved 
that  muscles  were  indispensable  to  the  accomplishment  of 
voluntary  motions.  Galen  was,  perhaps,  the  first  vivisector 
of  all,  since  he  exposed  muscles  of  living  animals,  and 
showed  how  alternate  tension  and  relaxation  of  distinct 
groups  set  the  bones  in  motion,  after  the  manner  of  levers ; 
he  named  a  great  number  of  them,  but,  curiously,  took 
no  note  of  others.  His  classification  according  to  their 
uses  is  followed  down  to  the  present  day — i.e.,  flexoi*s, 
extensors,  etc. 

The  Hippocratic  authors  confounded  the  arteries  with 
the  veins.  Praxagoras  first  distinguished  two  kinds  of 
vessels  which  he  supposed  to  contain  air,  whence  the  name 
artery.  Aristotle  and  Erasistratus  maintained  this  view, 
which  prevailed  until  the  time  of  Galen,  who  devoted  a 
book  to  the  refutation  of  it,  basing  his  argument  upon  the 
observation  that  always  when  an  artery  is  wounded  blood 
gushes  out.  How  near  he  came  to  being  the  discoverer  of 
the  circulation  may  thus  be  seen.  A  little  less  reverence 
for  authority  and  a  little  more  capacity  for  observation 
would  have  placed  him  in  possession  of  the  knowledge, 
lack  of  which  for  so  many  centuries  retarded  the  whole 
profession.  He  thought  the  veins  originated  from  the  liver 
— in  this  res|)ect  being  behind  Aristotle — but  considered 
the  heart  as  the  common  source  of  the  arteries  and  veins. 
Even  the  portal  system  of  veins  confused  him,  and  he 
erroneously  described  a  superior  and  inferior  aorta,  but 
atoned  for  this  by  describing  the  umbilical  veins  and  ar- 
teries. Aristotle  also  had  supposed  all  the  nerves  orig- 
inated from  the  heart,  but  Galen  stated  that  they  are  de- 
rived from  the  brain  and  spinal  marrowy  and  pointed  out 
two  kinds  of  nerves :  those  of  sensation,  which  he  thought 
proceeded  from  the  brain,  and  those  of  motion,  which  he 


WHAT    GALEN    DID    FOR    ANATOMY.  41 

considered  to  originate  in  the  spinal  marrow.  Thus,  he 
described  distinct  nerves  of  sensation  and  motion,  but  sadly 
confused  their  anatomy.  He  seems  also  to  have  had  some 
notion  of  the  great  sympathetic,  although  it  was  by  no 
means  accurate.  He  suggested  the  division  of  the  prin- 
cipal nerves,  in  order  to  prove  the  fact  that  nervous  energy 
is  transmitted  from  the  encephalon  to  other  parts  of  the 
body.  He  speaks  of  glands,  and  thought  they  discharged 
their  secretions  through  veins  into  the  various  cavities,  but 
regarded  them  rather  as  receptacles  of  excrementitious 
matter  than  as  agents  for  secretion  of  valuable  fluids.  He 
even  regarded  the  mammae  as  glandular  bodies  in  this 
sense,  although  he  knew,  of  course,  the  value  of  their 
secretion.  To  Galen  we  owe  the  division  of  the  body  into 
cranial,  thoracic,  and  abdominal  cavities,  whose  proper 
viscera  and  envelopes  he  described.  He  spoke  of  the  heart 
as  having  the  appearance  of  a  muscle,  but  differing  from 
it.  He  regarded  it  as  the  source  of  natural  heat,  and  the 
seat  of  anger  and  of  violent  passions.  He  appreciated  that 
inspiration  is  carried  on  by  enlargement  of  the  thoracic 
cavity.  He  thought  that  atmospheric  air  entered  the  cavity 
of  the  cranium  through  the  cribriform  plate  of  the  ethmoid 
and  ])assed  out  by  the  same  route,  carrying  with  it  excre- 
mentitious humors  from  the  brain,  which  were  discharged 
into  the  nasal  fossae.  But  some  portion  of  air  tlius  entering 
remained,  according  to  his  views,  and  combined  with  the 
vital  spirits  in  the  anterior  ventricles  of  the  brain,  from 
which  combination  originated  the  animal  spirits  and  im- 
mediate agents  of  the  rational  soul.  These  acquired  their 
last  attenuation  in  the  fourth  ventricle,  whence  they  would 
pass  out  drop  by  drop  through  a  round,  narrow  tube. 

From  this  brief  resume  of  the  anatomy  and  physiology 
of  Galen  it  will  be  seen  that  by  the  end  of  the  second  cent- 
ury of  the  Christian  era  immense  progress  had  been  made 
since  the  foundation  of  the  Alexandrian  school,  and  that  it 
was  due  to  the  impetus  in  the  study  of  anatomy  given  by 


42  THE    HISTORY    OF   MEDICINE. 

Herophilus  and  Erasistratus,  who  not  only  made  numer- 
ous dissections,  but  resorted  to  frequent  vivisections.  It  is 
even  said  that  Herophilus  did  not  hesitate  to  employ  his 
knife  on  live  criminals  who  were  subjected  to  him  for 
experiment ;  but  this  has  been  a  popular  tradition  about 
almost  every  anatomist  of  antiquity,  and  there  is  no  evi- 
dence in  confirmation  of  the  unkind  rumor,  altliough  that 
such  experiments  might  be  legally  and  justly  performed 
lias  occurred  to  the  minds  of  many.  But  zeal  for  dissec- 
tion rapidly  cooled  off,  and  Galen  barely  mentions  five  or 
six  men  who  devoted  themselves  to  it  in  the  space  of  nearly 
four  hundred  years  down  to  his  time.  He  speaks  of  Rufus 
of  Ephesus,  wlio  lived  under  Trajan ;  of  Marinus,  who 
wrote  in  the  beginning  of  tlie  second  century  a.d.  ;  and  of 
Quintus,  who  instructed  his  own  preceptor.  None  of  them 
left  a  reputation,  however,  approaching  that  of  Herophilus 
and  Erasistratus,  with  whom  Galen  alone  could  compare 
by  the  number  of  his  experiments  and  his  discoveries. 
Galen  strove  as  hard  as  one  of  his  position  might,  by  ex- 
ample and  precept,  to  awaken  in  his  contemporaries  a 
desire  for  anatomical  knowledge,  but  could  not  overcome 
their  indifference.  After  him  the  practice  of  dissection 
appears  to  have  been  lost,  either  from  the  redoubled  preju- 
dices of  the  superstitious,  wlio  opposed  it,  or  as  the  result 
of  the  apatlietic  ignorance  or  the  ignorant  apathy  of  the 
physicians. 

It  has  been  shown  that,  during  tlie  Hippocratic  era  and 
subsequently,  the  physicians  even  of  primitive  times  fol- 
lowed more  or  less  by  instinct  the  empirical  method. 
Acron  of  Agrigentum  was  a  contemporary  of  Pythagoras, 
and  affirmed  that  experience  is  the  only  true  foundation  of 
tlie  liealing  art.  Hippocrates,  however,  showed  himself 
more  anxious  to  report  faithfully  clinical  facts  than  to  dis- 
pute theoretical  views. 

The  surprising  progress  in  anatomy  and  physiology 
made  during  the  first  portion  of  the  Anatomic  Period  and 


galen's  influence.  43 

during  the  better  days  of  the  Alexandrian  institute  did  not 
keep  men  from  confounding  several  different  points  in  the 
Hippocratic  doctrine,  by  which  confidence  in  the  same  was 
naturally  shaken.  Thus  many  new  speculations  were 
hazarded  which  nullified  each  other.  In  the  midst  of  this 
confusion  practitioners  continued  to  seek  in  experience  a 
refuge  from  the  incessant  variations  of  dogmatism  and  the 
sterile  incertitude  of  the  skeptics.  Thus,  empiricism  as  a 
school  of  practice  became  placed  upon  a  firmer  and  firmer 
foundation,  and  the  empirics  of  that  day  seem  to  have  laid 
the  true  basis  of  our  art.  Their  doctrine  took  at  first  a 
rapid  growth,  and  Galen  spoke  of  it  with  great  regard. 
The  circumstances  under  which  it  was  proclaimed  were 
most  favorable  .  for  its  propagation.  Theories  had  fallen 
into  confusion ;  practice,  methods,  and  opinions  were 
questionable.  Everything  was  conjecture,  and  that  which 
rested  on  the  evidence  of  facts  was  by  the  empirics  received 
with  enthusiasm.  Although  founded  on  pure  observation, 
it  did  not  put  an  end  to  differences  of  opinion,  and  in  the 
eyes  of  the  ancients  it  lacked  in  solidity,  because  it  did  not 
attach  itself  to  any  philosophic  theory  then  known.  This 
doctrine  was  then  best  able  to  captivate  physicians  on  ac- 
count of  its  simplicity,  contrasted  with  the  general  inability 
to  satisfy  speculative  minds ;  but  for  this  very  reason  it 
subsequently  fell  into  disgrace,  and  the  term  "  empiricism  " 
became  synonymous  with  ignorance.  For  centuries  con- 
demned and  despised,  it  was  revived  from  its  long  humili- 
ation under  the  name  of  the  Experimental  Method,  and 
achieved,  after  the  labors  of  Bacon,  Locke,  and  Condillac, 
almost  universal  dominion  in  the  sciences. 

This  doctrine  had  been  proclaimed  for  about  a  century 
during  the  period  of  which  we  now  speak,  but  later  led 
men  into  a  fondness  for  secondary  generalities  or  for  the 
elevation  and  magnifying  of  trifles,  which  confused  their 
minds  and  terminated  its  usefulness  to  science.  Mean- 
while, a  man   of  great  intelligence,  renovvned  as  an  elo- 


44  THE    HISTORY    OF    MEDICINE. 

cutionist,  well  versed  in  the  doctrine  of  philosophers  and 
grammarians — namely,  Asclepiades,  of  Bithynia — came  to 
Rome  with  the  intention  of  teacliing  rhetoric.  By  his 
talent  and  personal  address  he  soon  hecanie  one  of  the  most 
illustrious  persons  in  the  Roman  Repuhlic  ;  so  early  as  100 
B.C.  he  enjoyed  a  high  reputation  as  a  rhetorician,  -and 
was  later  an  intimate  friend  of  Cicero;  nevertheless,  he 
abandoned  letters,  undertook  the  practice  of  medicine,  and 
sought  moreover  to  create  a  new  system,  being  unwilling 
to  follow  in  the  track  of  his  predecessors.  Imbued  witli 
the  philosophy  of  Epicurus,  who  was  then  in  high  repute, 
he  deduced  from  it  a  theory  which  was  in  harmony  with 
the  philosophy  of  the  day.  He  thought  that  the  elements 
of  the  body  existed  from  eternity ;  that  they  were  indi- 
visible, impalpable,  and  perceptible  to  the  reason  only. 
These  elements  he  named  atoms,  which  were  supposed  to 
be  animated  by  perpetual  motion,  and  from  which,  by  their 
frequent  encounters  and  fortuitous  contention,  all  sensible 
phenomena  were  supposed  to  result.  He  explained  the 
properties  of  the  body  by  saying  that  compounds  were 
aggregates  of  atoms,  differing  very  much  from  atoms  them- 
selves. Solid  silver,  he  said,  is  white,  but,  reduced  to 
powder,  appears  black  ;  the  horn  of  the  goat,  on  the  con- 
trary, is  black,  but  if  it  be  razed  its  particles  are  white. 
This,  it  will  be  seen,  was  the  parent  of  our  present  atomic 
theory.  He  ridiculed  the  theories  of  Hippocrates  concern- 
ing coction,  crises,  etc.,  and  sarcastically  called  the  Hi})poc- 
ratic  treatise  on  therapeutics  "a  meditation  on  deatli." 

Asclepiades  based  his  own  therapeutics  on  endeavors 
so  to  enlarge  the  pores  of  the  human  body  that  disease 
could  find  egress,  or  so  to  constrict  them  that  it  could  not 
enter  ;  consequently  he  rejected  all  violent  remedies,  such 
as  vomits,  purges,  etc.,  and  his  favorite  remedies  were 
hygienic, — for  the  most  part  bodily  exercise. 

A  celebrnted  disciple  of  Asclepiades  was  Themison,  of 
Lnodicen   (b.c.  50).  who   wns  led  by  th(^   tcnrhings  of  his 


THE    DOCTRINES   OF    GALEN 's    SUCCESSORS.  45 

master  to  lay  the  ibiindation  of  the  so-called  Methodism  as 
opposed  to  Dogmatism  in  the  school  of  Cos.  By  him  and 
his  followers  a  very  arbitrary  arrangement  of  diseases  was 
made,  according  to  what  they  considered  the  constrictive, 
or  contractive;  the  fluxionary, — congested  or  relaxed;  and 
the  mixed  forms.  From  this  division  of  diseases  it  appears 
that,  according  to  the  methodists,  there  were  only  two 
kinds  of  therapeutic  indications  to  follow, — namely,  to 
relax  where  there  was  constriction,  to  constrict  where  there 
was  relaxation.  They,  however,  admitted  a  third  credit- 
able result,  which  they  called  prophylactic ;  but  the  pure 
methodists,  such  as  Coelius  Aurelianus,  admitted  neither 
specific  disease  nor  specific  remedies,  and  erased  from  their 
materia  medica  purgatives,  diuretics,  emmenagogues, 
nauseants,  etc. 

According  to  the  methodist  doctrine,  the  study  of  medi- 
cine was  so  abridged  that  one  of  its  prominent  exponents 
said  that  he  felt  able  to  teach  the  whole  of  medical  science 
in  six  months.  It  made  rapid  progress,  and  consequently 
was  most  attractive  to  tlie  numerous  young  neophytes  who 
were  anxious  to  finish  their  apprenticeship  and  hasten  into 
practice.  It  is  not  one  of  the  smallest  of  the  services 
which  Galen  rendered  to  his  time  and  to  posterity  that  he 
demolished  the  sophistry  of  the  methodists,  demonstrated 
the  insufficiency  of  their  practice,  and  brought  to  bear 
upon  them  the  wittiest  satire,  calling  them  the  asses  of 
Thessaly,  alluding  thereby  to  their  lack  of  literature  and 
medical  instruction. 

In  summing  up,  then,  the  basis  for  the  various  systems 
of  medicine  during  this  period  of  antiquity,  it  is  seen  that 
the  most  ancient  doctrine  of  all — Dogmatism — directs  our 
attention  especially  to  the  animal  economy  in  health  and 
disease ;  that  it  took  account  of  the  union  of  vital  forces, 
of  sympathies  in  the  organism,  and  of  nature's  efforts  to 
repel  both   internal  and   external   deleterious   influences, 


46  THE    HISTORY    OF    MEDICINE. 

which  providential  tendency  manifests  itself  especially  in 
certain  acute  diseases.  This  was  the  strong  side  of  dog- 
matism. Its  weak  side  consisted  in  this:  that  it  was  held 
that  the  causes  of  diseases  inhere  in  the  access  of  certain 
qualities  and  humors  along  with  organic  forces, — such  as 
dryness  or  moisture  in  combination  with  bile  or  atrabile, — 
and  the  treatment  was  directed  against  these  supposed 
causes.  It  was  on  account  of  this  weakness  that  the 
enemies  of  dogmatism  attacked  it.  The  empirics  opposed 
the  idea  that  inaccessible  and  occult  causes  of  disease 
could  become  the  basis  for  rational  treatment.  They 
affirmed  that  there  was  no  consistent  relation  of  antago- 
nism or  similitude  between  the  disease  and  the  remedies 
which  cured  it. 

The  Methodists  somewhat  improved  on  the  doctrine  of 
empiricism,  but  ran  wild  in  its  improvement  and  erected 
over  their  fundamental  theory  such  a  superstructure  of 
secondary  and  tertiary  generalities  as  to  cause  the  funda- 
mental part  to  be  entirely  obscured  from  sight. 

There  were  not  lacking,  in  tliose  days  of  old,  certain 
educated  physicians  who  more  or  less  vaguely  compre- 
hended that  the  entire  truth  of  medicine  did  not  inhere  in 
any  one  of  these  systems,  but  that  there  was  good  and 
evil  in  each.  Tliese  men,  not  being  able  to  establish 
general  rules,  tried  to  decide  practical  questions  according 
to  their  fancy  or  their  reason.  They  assumed  the  name  of 
Eclectics  or  Episynthetics^  meaning  thereby  that  they 
adopted  no  exclusive  system,  but  selected  from  each  that 
which  seemed  to  them  best.  They  did  not  constitute  a 
sect,  because  they  had  no  precise  dogmas  nor  theories,  but 
they  should  not  be  confounded  with  the  Pyrrhonians,  who 
held  to  doubt  as  a  fundament  doctrine,  the  true  eclectic 
doubting  only  tliat  which  he  could  not  understand.  True 
eclecticism  in  medicine,  however,  is  rather  the  absence  of 
fixed  principles,  or,  as  Renouard  says,  it  is  "  individualism 
erected  into  a  dogma,  whicli  escapes  refutation  because  it 


THE    AGE   OF   TRANSITION."  47 

is  deficient  in  principle."  Many  became  eclectics  to  avoid 
discussing  principles,  and  made  of  it  a  shelter.  In  one 
sense,  then,  an  eclectic  is  one  destitute  of  profound  con- 
victions, who  sides  with  no  particular  party,  is  committed 
to  no  person  or  doctrine,  and  who  is  often  so  indifferent 
that  he  cannot  judge  with  impartiality;  consequently,  to 
be  truly  eclectic  is  different  from  being  an  adherent  of  a 
scliool  of  eclecticism. 

During  the  historic  period  just  reviewed,  anatomy  and 
physiology  made  most  progress,  next  internal  and  external 
nosography,  and  next  to  these  medical  and  surgical  thera- 
peutics, and  althougli  Coelius  Aurelianus  and  Aretaeus 
have  left  to  us  by  far  the  best  books  issued  up  to  their 
times,  nevertheless  not  one  of  the  writers"  of  this  period 
has  achieved  the  distinction  in  which  Hippocrates  is  held, 
since  he,  perhaps  more  than  any  other,  combined  intelli- 
gence, sincerity,  disinterestedness,  love  of  his  art,  and 
humanity. 

Under  the  classification  of  Renouard,  already  alluded 
to,  the  so-called  Age  of  Transitimi  includes  centuries  com- 
mencing with  the  death  of  Galen,  about  a.d.  201,  and 
ending  with  the  revival  of  letters  in  Europe,  about  the 
year  1400.  The  first  period  of  this  transition  age  is  the 
so-called  Greek  Period,  which  ends  with  the  burning  of 
the  Alexandrian  library,  a.d.  640. 

At  tlie  time  when  this  historic  period  commenced  all 
the  known  world  was  under  the  dominance  of  a  single 
man.  The  power  of  Septimus  Severus  had  more  extent 
than  that  of  iVlexander  the  Great,  and  bid  fair  to  })e  of  a 
much  longer  existence.  The  Roman  dominion,  cemented 
by  seven  hundred  years  of  bold  and  persevering  govern- 
ment, seemed  almost  immovable.  While  the  savages  upon 
its  frontiers  occasionally  troubled  its  peace,  none  were  strong 
enough  to  penetrate  its  centres  or  place  it  in  real  peril. 
The  great  civil  wars  had  ceased,  or  changed  their  object. 


48  THE   HISTORY   OF   MEDICINE. 

Both  the  people  and  the  senate,  those  two  eternal  competi- 
tors, had  gotten  over  the  struggle  for  supreme  power; 
monarchial  government  was  accepted  as  a  matter  of  fact, 
and  the  citizens  contended  only  for  choice  of  a  master. 

Similar  changes  had  taken  place  in  the  domain  of  the 
mind  ;  philosophical  discussions,  which  were  so  essentially 
a  part  of  the  schools  of  the  ancient  Greeks,  had  nearly  lost 
their  interest  and  were  being  discontinued.  Such  disputes 
as  took  place  related  less  to  principle  than  to  interpretation 
of  the  language  of  the  teacher.  In  morals,  Plato,  Epicu- 
rus, and  Zeno  were  followed  until  the  principles  of  Chris- 
tianity gradually  supplanted  their  teaching  ;  in  physics  and 
metaphysics  the  authority  of  Aristotle,  and  in  medicine  that 
of  Galen,  were  simply  undisputed. 

Conditions  being  such  as  these,  there  was  naturally  but 
one  sect  in  medicine,  and  one  method  of  study  and  practice. 
Medical  science  retrograded  rather  than  progressed,  sad  to 
say,  and  was  undisturbed  by  any  remarkable  revolution. 
The  scepter  of  medicine  passed  from  the  hands  of  one 
nation  to  those  of  another,  and  the  language  of  Hippocrates 
and  Galen  was  later  replaced,  as  will  duly  be  seen,  by  that 
of  Avicenna  and  Albucassis.  But  this  Greek  Period, 
which  is  one  of  transition,  offers  little  for  our  consideration 
more  than  the  lives  and  writings  of  four  of  its  most  emi- 
nent physicians,  who  by  their  study  in  tlie  school  of  Alex- 
andria, and  by  their  writings  and  teachings,  left  reputations 
which  were  sustained  until  the  invasion  of  the  Arabs.  Of 
these  it  may  be  said  that,  while  they  did  little  or  nothing 
original,  and  simply  commented  upon  the  writings  of  Hip- 
pocrates and  Galen,  they  kept  burning  the  torch  of  medical 
learning  which  else  had  been  almost  extinguished  by  their 
indolent  contemporaries.  Of  these  various  commentators — 
for  they  were  little  more  than  that — the  first  of  any  impor- 
tance after  Galen  was  Oribasius,  who  was  born  in  Perga- 
mos  (326-403) ;  lie  early  attached  liimself  to  the  fortunes 
of  Julian  the  Apostate,  and  followed  him  into  Gaul  when 


THE   GREEK   PERIOD.  49 

he  was  made  its  governor.  Julian  appreciated  the  good 
qualities  of  Oribasius,  made  him  an  intimate  friend,  and 
after  he  himself  became  emperor  appointed  his  friend 
as  quaestor  at  Constantinople.  After  the  emperor's  un- 
timely death,  Oribasius  remained  faithful  to  his  memory, 
but  his  jealous  colleagues  so  falsely  and  so  successfully 
misrepresented  his  fidelity  that  he  was  disgraced,  spoiled  of 
his  office  and  property,  and  banished  among  a  barbarous 
people.  In  this  new  field,  however,  he  displayed  such 
courage,  effected  such  extraordinary  cures,  discoursed  so 
eloquently,  and  so  attached  to  himself  the  savage  men 
around  him,  that  he  was  by  them  regarded  as  a  god.  The 
fame  of  this  homage  in  time  reached  the  ears  of  the  Em- 
perors Valens  and  Valentinianus,  wlio  recalled  him,  reim- 
bursed him  for  his  losses,  and  permitted  him  to  enjoy  his 
high  reputation  and  fortune  to  the  end  of  his  days.  He 
Avas  held  to  be  the  wisest  man  of  his  time,  most  skillful  in 
medicine,  and  the  most  charming  in  conversation.  He 
dedicated  a  collection  of  seventy  books  to  Julian,  his  first 
patron,  and  edited,  at  a  later  period,  an  abridgment  of  this 
work  for  the  benefit  of  his  son.  His  principal  merit  con- 
sisted in  reproducing  the  ideas  of  others  with  such  clear- 
ness, order,  and  precision  that  the  summaries  that  he  gives 
of  them  are  often  preferable  to  the  originals.  AVhat  he  has 
said  of  pregnant  women,  nursing,  and  the  earliest  educa- 
tion of  the  child  has  been  copied  literally  by  writers  for 
twelve  centuries  since  his  time.  It  must  be  said  of  liim, 
however,  that  his  prepossession  in  favor  of  Galen  was  so 
great  that  he  adopted  servilely  his  ideas  and  even  his 
words  to  such  an  extent  that  he  has  been  surnamed  "  the 
ape  of  Galen." 

^tius  was  born  in  Mesopotamia  in  the  year  502  and 
died  in  575.  He  studied  at  Alexandria,  and  afterward  went 
to  Constantinople,  where  he  became  a  chamberlain  at  court. 
^tius  was  the  first  medical  man  of  any  note  who  professed 
Christianity,  as  is  shown  by  such  passages  as  this  one:  he 


50  THE   HISTORY    OF   MEDICINE. 

said  tliat  in  the  composition  of  certain  medicaments  the 
following  words  should  be  repeated  in  a  low  voice:  "May 
the  God  of  Abraham,  the  God  of  Isaac,  and  the  God  of 
Jacob  deign  to  bestow  upon  this  medicament  such  and  such 
virtues."  In  another  place  he  recommends  tliat  to  extract 
a  bone  from  the  throat  the  following  words  be  pronounced: 
"  Bone — as  Christ  caused  Lazarus  to  come  forth  from  the 
sepulchre,  as  Jonah  came  out  of  the  wliale's  belly — come 
out  of  the  throat  or  go  down."  But  he  exhibits  the  same 
credulity  in  not  doubting  the  miraculous  virtues  attributed 
by  the  quacks  of  his  day  to  most  remedies. 

Like  Oribasius,  he  collected  everything  that  he  found 
remarkable  in  the  writings  of  his  predecessors,  and  has 
preserved  certain  fragments  of  antiquity  which  would  other- 
wise have  been  lost.  His  work  formed  a  complete  manual 
of  medicine  and  surgery,  except  that  it  lacked  anatomical 
descriptions  and  references  to  dislocations  and  fractures. 

Alexander  of  Tralles  (525-605),  a  city  of  Lydia,  where 
Greek  was  spoken,  was  a  son  of  the  physician  Stephen,  and 
the  most  celebrated  of  five  sons,  wlio  were  all  distinguished 
for  their  learning.  He  traveled  extensively,  and  fixed  his 
residence  in  Rome,  where  he  became  celebrated.  He  lived 
to  an  advanced  age,  and,  being  no  longer  able  to  practice, 
composed  a  treatise  of  twelve  books,  exclusively  devoted  to 
affections  that  did  not  require  the  aid  of  surgery.  He  j)ro- 
fessed  the  greatest  veneration  for  Galen,  but  did  not  blindly 
adopt  his  opinions.  He  described  the  first  reported  case  of 
excessive  hunger  and  pain  due  to  intestinal  worms;  he 
advised  venesection  in  the  foot  rather  tlian  in  the  arm;  but 
with  all  his  sound  judgment  and  mentfd  enliglitenment  he 
had  faith  in  amulets  and  talismans,  and  widely  recommended 
tliem.  It  may  be  said  for  him,  such  was  the  universal 
prejudice  of  his  age,  the  whole  world  being  plunged  in 
superstition,  that  it  was  necessary  for  every  one  to  pay 
some  tribute  to  the  prevailing  belief;  and  we  may  add 
that  it  is  necessary  to  make  this  excuse  for  some  who  prac- 


PAULUS  iEGINETA.  51 

tire  much  nearer  to  ourselves  than  did  those  ancient 
physicians. 

Paul,  or  Faulus,  surnamed  ^gineta  (because  he  was 
born  in  the  Island  of  ^gina),  was  among-  the  last  of  the 
Greek  physicians  who  have  special  interest  for  us.  It  is 
supposed  that  he  died  about  a.d.  690.  He  traveled  exten- 
sively, and  his  skill  in  surgery  and  obstetrics  rendered  him 
celebrated  even  among  the  Arabs,  wliose  midwives  sent 
for  liim  in  consultation  from  great  distances.  He  composed 
a  compendium  of  medicine,  divided  into  seven  books,  and 
not  only  did  not  hesitate  to  borrow  from  his  predecessors, 
but  quoted  from  them  most  extensively ;  a  number  of  his 
chapters  were  taken  almost  verbatim  from  Oribasius ;  how- 
ever, he  made  no  secret  of  it,  but  rather  boasted  that  he  had 
judiciously  sought  to  appropriate  the  best  of  the  writings 
of  those  he  most  revered.  He  showed  originality,  however, 
in  the  treatment  of  hydrocephalus,  in  advising  paracentesis 
of  the  thorax  and  abdomen,  in  the  extraction  of  calculi 
from  the  bladder,  in  the  treatment  of  aneurism,  the  excision 
of  hypertrophied  mammse  in  men,  etc.  He  was  the  first  to 
describe  varicose  aneurism,  and  the  first  to  perlbrm  the 
operation  of  bronchotomy  after  the  method  borrowed  from 
Antyllus,  of  which  he  has  transmitted  a  very  detailed 
account.  Of  this  Antyllus,  by  the  way,  it  may  be  added, 
ei I  passant,  that  he  was  one  of  the  most  distinguished  and 
original  surgeons  of  antiquity.  He  flourished  during  the 
third  century  after  Christ ;  was  the  first  to  describe  the 
extraction  of  small  cataracts ;  and  is,  perhaps,  best  known 
to  the  surgical  world  to-day  by  his  exceedingly  bold  plan 
of  opening  aneurisms,  so  successfully  imitated  a  generation 
or  so  ago  by  James  Syme. 

It  has  already  been  seen  that  before  and  during  the 
early  centuries  of  the  Cliristian  era  the  secrets  and  learning 
of  the  physicians  tended  to  pass  gradually  into  the  hands 
of  the  priests.  It  was  so  in  the  temples  of  ancient  Greece, 
it  was  so  in  Alexandria,  it  became  so  in  Rome,  it  has  been 

L 


1   KIC 


.62  THE    HISTORY    OF    MEDICINE. 

SO  even  in  modern  times,  although  only  for  brief  periods  of 
time.  This  has  come  about  in  some  measure  from  the 
cupidity  of  the  clerical  orders,  partly  because  it  required  a 
certain  amount  of  intelligence  and  knowledge  to  become  a 
priest,  and  partly  because,  owing  to  ignorance,  credulity, 
and  superstition,  diseases  have  at  all  times  been  regarded 
by  the  ignorant  as  evidence  of  divine  wrath  and  chastise- 
ment, or  of  diabolical  or  occult  influences,  rather  than  the 
effect  of  natural  causes.  Hence  men  have  turned  ever 
toward  prayers,  exorcism,  -and  expiation,  especially  when 
exhorted  thereto  by  the  priests.  This  has  been  the  sacer- 
dotal aspect  of  the  practice  of  medicine  in  all  times,  and 
when  the  priests  have  usurped  therapeutic  functions  they 
have  done  harm  rather  than  good.  So  long  as  theology 
and  science  work  hand  in  hand,  each  redounds  to  the  credit 
of  tlie  other,  but  always  in  the  history  of  man  when  theol- 
ogy has  appropriated  that  which  did  not  belong  to  it  it 
has  brought  ridicule  upon  itself  and  has  delayed  the 
progress  of  knowledge.  There  have  been  frequent  rebell- 
ions against  religious  authority  in  ancient  as  in  modern 
times.  For  instance,  at  the  commencement  of  the  fiftb 
century  before  Christ  the  Pythagoreans  were  dispersed,  and 
the  doctrines  of  Cos  and  Cnidus — i.e.,  the  Hippocratic 
teachings — were  promulgated;  and,  again,  in  the  course  of 
events,  when  the  descendants  of  ^Esculapius  became  servile 
attendants  at  the  temple  and  adjuncts  to  the  priesthood  or 
a  part  of  it.  At  first,  in  Alexandria,  the  physicians  were 
supreme ;  their  disciples,  however,  had  the  same  blind 
reverence  for  authoritv  that  too  manv  workers  in  the  field 
of  theology  have  evinced,  and  men  once  more  practiced 
medicine  on  the  traditions  of  the  past,  and  in  so  doing 
allied  themselves  more  and  more  to  the  temples. 

In  Rome,  at  first,  the  oldest  and  best  instructed  of  the 
relatives  treated  the  diseases  of  his  family  as  he  understood 
them ;  simply  shared  this  duty  with  its  other  members. 
Cato.  the  censor,  was  much  engrossed  with  this  domestic 


ROME   DURING   THE   GREEK   PERIOD.  53 

medicine ;  he  wrote  a  book  in  which  he  recommended 
cabbage  as  a  sovereign  remedy  in  many  diseases.  He 
venerated  the  number  3,  as  did  tlie  Pythagoreans ;  did 
not  disdain  to  transmit  to  posterity  certain  medical  words 
which  it  was  believed  should  be  repeated  to  assist  in  the 
reduction  of  dislocations  and  fractures.  This  old  censor 
seemed  to  have  a  profound  hatred  for  medical  men,  and 
most  absurd  ideas  of  their  works  and  claims,  although 
doubtless  many  Greek  physicians  who  came  to  Rome 
merited  tlie  invectives  wliich  he  launched  against  them. 
Then  came  Asclepiades,  of  Bithynia,  as  already  mentioned, 
whose  talents  were  far  superior  to  those  of  his  Roman  con- 
temporaries, and  who  did  not  need  to  call  to  his  aid  charla- 
tanism and  deceit.  This  medical  hero  unfortunately  had 
many  worthless  and  dishonest  imitators,  who  appealed  to 
superstition  and  ignorance  in  every  dislionest  way,  and  who 
desired  to  be  judged  by  the  luxury  and  elegance  they  dis- 
played. Hence  for  a  long  time  in  Rome  medicine  was 
practiced  without  license.  The  Emperor  Anthony  the 
Pious  was  the  first  to  occupy  himself  with  regulating  the 
practice  of  medicine.  He  granted  certain  immunities,  but 
did  ask  for  proof  of  qualifications.  A  certain  physician  to 
Nero,  Adromachus,  was  honored  by  the  emperor  with  the 
title  of  Archiater, — i.e.,  royal  healer, — but  Galen,  who  was 
physician  to  Marcus  Aurelius,  never  bore  it.  From  the 
time  of  Constantino  the  Great,  however,  the  title  is  fre- 
quently met  with  in  the  edicts  of  the  emperors.  In  fact, 
there  were  two  sorts  of  these, — one  named  the  Palatine, 
who  belonged  to  the  household  of  the  reigning  monarch 
and  who  held  high  rank  among  the  nobility;  and  the  other 
called  the  Popular  Archiaters,  who  were  public-health  offi- 
cers. No  one  could  practice  medicine  in  the  jurisdiction 
of  one  of  these  without  examination  and  authorization. 
Those  who  transgressed  this  regulation  were  punished  -with 
a  fine  of  two  thousand  drachmas.  Tlie  Popular  Archiaters 
were  pensioned  by  the  city,  enjoyed  certain  privileges,  and 


64  THE    HISTORY   OF    MEDICINE. 

had  to  attend  the  poor  gratuitously.  Practitioners  who 
were  not  members  of  the  College  of  Archiaters  had 
no  pay,  no  rights,  nor  emoluments.  The  Popular  Archia- 
ters were  elected  by  the  citizens  from  many  candidates  who 
had  proved  their  capacity  before  the  college  of  this  medical 
organization.  The  evils  of  medical  anarchy  were  thus 
remedied ;  this  happy  condition  existed  until  the  empire 
was  broken  up  by  barbarism. 

It  is  during  this  period — about  400  a.d. — that  we 
first  find  a  class  of  citizens  to  whom  was  delegated  the 
duty  of  preparing  drugs  ordered  by  physicians.  Their 
duties  were  in  some  respects  similar  to  those  of  our  apothe- 
caries, although  in  attainment  and  in  social  position  they 
were  far  below  the  physicians.  Tliey  were  termed  pharma- 
copoUsts. 

It  is  worth  while  to  stop  a  moment  to  inquire  wliat 
were  the  medical  charitable  institutions  of  antiquity. 
Even  in  the  days  of  ancient  Athens  there  was  a  certain 
gymnasium,  called  the  Cynosarges,  in  which  abandoned 
and  illegitimate  children  were  brought  up  at  public  ex- 
pense until  such  time  as  they  were  able  to  serve  their 
country.  A  little  later  several  private  institutions  of  this 
kind  were  established.  Rome  in  her  earlier  day  never  had 
such  institutions.  To  be  sure,  she  distributed  provisions, 
or  else  remitted  taxes,  to  parents  who  were  unable  to  sup- 
port their  children,  or  even  permitted  them  to  destroy 
their  newborn  children  when  unable  to  maintain  them  ; 
but  there  were  no  bonds  of  sympathy  wliich  induced  the 
patricians  to  succor  the  plebeians  in  time  of  disease  and 
distress;  slaves  were  cared  for  as  were  cattle.  It  is  one  of 
the  debts  we  owe  Christianity  that,  under  its  influence,  the 
first  almshouses  and  retreats  were  established  in  Rome. 
It  has  been  said  that  the  Emperor  Marcus  Aurelius  first 
instituted  anytliing  like  a  dispensary  service  in  the  Sacred 
City.  We  are  told,  also,  of  an  illustrious  woman,  St. 
Pauline,  living   in  the   midst  of  the   greatest   wealth   and 


ANCIENT   CHARITABLE   INSTITUTIONS.  55 

pomp,  who  retired  from  society  and  devoted  her  life  to 
charity  and  self-denial.  She  went  to  Jerusalem,  united 
with  other  Christian  women  of  the  same  mission,  and 
formed,  under  the  direction  of  St.  Jerome,  a  sisterhood 
whose  members  divided  their  time  between  reading  sacred 
books  and  doing  good  works.  They  offered  an  asylum  for 
the  faithful  and  a  hospice  for  the  benefit  of  the  indigent 
sick,  and  even  established  a  home  for  convalescents  outside 
the  city-walls.  After  the  model  thus  set,  heathen  emperors, 
Christian  kings,  and  Moslem  caliphs  showed  their  zeal  in 
this  good  direction  by  the  erection  of  sumptuous  edifices 
and  otlier  ricli  endowments  for  the  reHef  of  suffering- 
human  beings. 

Reviewing  now  the  Greek  period,  let  it  be  remembered 
that  in  the  time  of  Galen  animals  were  dissected,  and  that 
he  made  anatomical  demonstrations  on  monkeys ;  that 
sometimes  the  corpses  of  tlie  enemy  were  rudely  dissected 
upon  the  field  of  battle,  but  that  finally  the  practice  of 
dissection  fell  into  disuse,  and  human  anatomy  was  studied 
only  from  books,  the  early  Christians  having  evinced  even 
more  horror  of  the  dead  body  for  the  purposes  of  anatom- 
ical study  than  did  their  pagan  predecessors,  while  the 
Fathers  of  primitive  times  launched  their  anathemas 
against  the  dissection  of  human  remains.  Here,  again,  as 
usual,  the  interference  of  the  church  worked  only  general 
harm.  This  abandonment  of  anatomy  contributed  doubt- 
less to  the  decadence  of  medicine ;  by  the  rapid  extension 
of  Christianity  the  pagan  schools  were  disorganized  and 
broken  up,  the  profane  sciences  (such  as  medicine)  were 
discarded,  and  the  teachers  still  remaining  in  the  old 
schools  were  ruined.  Passion  for  religious  controversy 
was  engendered  and  took  the  place  of  study  or  original 
research,  even  to  such  an  extent  as  to  hasten  the  fall  of 
the  Empire  of  the  East.  In  addition  to  these  factors,  rev- 
erence for  authority  of  the  past — that  terribly  oppressive 
weight  which  has  kept  down  so  much  which  would  other- 


56  THE   HISTORY   OF    MEDICINE. 

wise  have  risen  early,  and  which  has  been  the  greatest 
enemy  of  human  learning — permitted  the  explanation  of 
natural  phenomena  to  be  sought  only  in  the  writings  of 
revered  ancients,  and  not  in  living  beings.  No  one  dared 
to  advocate  changes  in  regard  to  received  doctrines,  and 
there  could  be  no  such  thing  as  progress.  Only  two  men 
in  the  lapse  of  four  centuries  showed  any  originality; 
these  were  Alexander  of  Tralles  and  Paul  of  ^gina, 
whose  lives  have  already  been  briefly  rehearsed.  It  is 
with  some  relief,  however,  that  we  can  think  that  this 
period,  so  unfruitful  in  scientific  progress,  was  not  so  in 
social  amelioration.  By  the  organization  of  the  institu- 
tions above  alluded  to  charlatanism  was  checked,  by  the 
requirement  of  capability  and  good  character  society  was 
benefited,  and  the  charitable  institutes  of  this  epoch  per- 
haps gave  the  world  its  best  models  in  teaching  and  an 
insight  into  the  most  valuable  means  of  medical  instruc- 
tion. Of  the  old  Greek  Period,  then,  Ave  may  say  that  it 
accrues  rather  to  the  benefit  of  humanity  than  to  that  of 
science. 


CHAPTER  III. 

Age  of  Teansition  {continued). — Arabic  Period:  A.D.  640-1400.  Alkindus, 
1 873.  Mesue,  777-857.  Kliazes,  850-932.  Haly-Abas,  f  994,  Avicenna, 
980-1037.  Albucassis,  t  1122.  Aveuzoar,  1113-1161.  Averroes,  1166- 
1198.  Maimonides,  1135-1204.  School  of  Salernum :  Constantinus  Afri- 
canus,  1018-1085.  Roger  of  Salerno,  1210.  Roland  of  Parma,  1250. 
The  Four  Masters,  1270  (?).     John  of  Procida. 

The  Arabic  Period,  which  began  with  the  second  de- 
struction of  the  Alexandrian  Library  —  640  a.d.  —  ends 
with  tlie  fourteenth  century.  At  the  commencement  of  this 
period  the  Roman  Empire  of  the  West  scarcely  existed : 
the  magnificent  territory  which  composed  it  had  been  over- 
run and  subdued  by  barbarous  tribes  from  the  forests  of  the 
North,  while  from  its  ruins  had  risen  several  independent 
kingdoms, — that  of  the  Franks  in  Gallia,  of  the  Visigoths 
in  Spain,  and  of  the  Lombards  in  Italy.  The  last  of  the 
AVestern  emperors  of  note  was  Justinian,  whose  army  and 
generals — especially  the  genius  and  heroic  devotion  of 
Belisarius — threw  some  glory  upon  Italy,  Sicily,  Africa, 
and  Spain.  Meantime  the  Empire  of  tlie  East,  surrounded 
by  enemies,  and  harassed  from  all  directions,  still  sustained 
itself  with  vigor.  The  Turks  had  begun  to  show  them- 
selves on  the  banks  of  the  Danube ;  those  eternal  enemies 
of  Rome — the  Persians — made  incessant  war ;  and  a  new 
and  terrible  enemy  had  sprung  up  in  the  deserts  of  Arabia. 
Then  came  one  who  was  at  the  same  time  legislator,  prophet, 
and  conqueror,  and  united  under  one  faith  and  one  leader 
tribes  hitlierto  divided  and  warring  against  each  other. 
Thus  arose  a  powerful  and  enthusiastic  nation,  animated 
by  thirst  for  conquest  and  ardor  for  proselytism.  In  less 
than  a  century  after  the  first  preaching  of  Mahomet,  all  of 
Arabia,  India,  Syria,  and  Egypt  were  in  the  hands  of  his 
followers.  Ip  the  year  640  Amrou  effected  the  conquest 
of  Egypt,  seized  Alexandria,  and  the  great  library  of  five 
hundred  thousand  volumes  was,  by  order  of  Omar  (snc- 

(57) 


58  THE   HISTORY   OF    MEDICINE. 

cessor  to  Mahomet),  delivered  over  to  the  flames;  and  the 
historian  Ahulphara«i^ius  declares  that  these  books  served 
for  six  montlis  to  heat  the  public  baths,  four  thousand  in 
number.  Such  were  the  first  fruits  of  tlie  establishment  of 
Islam.*  Happily,  zeal  of  proselytism  somewliat  abated 
among  the  Mussulman  princes,  and  religious  fervor  gave 
place  to  policy;  so  that  the  later  Arabian  caliphs  showed 
themselves,  in  general,  the  protectors  of  tlie  arts  and  sciences. 
Some,  indeed,  endeavored  to  collect  the  debris  of  the 
scattered  treasures  that  had  been  so  fortunate  as  to  escape 
the  ignorant  fanaticism  of  their  predecessors;  and  others, 
more  tolerant  even  than  the  Christian  princes  of  tlie  time, 
received  without  distinction  all  men  of  merit  who  took 
refuge  in  their  State,  gave  them  employment,  and  recom- 
pensed them  for  their  services.  On  this  account  pliiloso- 
phers  and  persecuted  ''heretics"  sought  an  asylum  among 
infidels,  and  found  there  the  protection  which  Christianity 
did  not  afford, — in  return  for  which  they  gave  their  pro- 
tectors the  benefits  of  Greek  civilization. 

Of  all  the  Moslem  rulers,  the  most  distinguished  for 
love  of  learning  and  general  enlightenment  was  Haronn- 
al-Raschid,  the  Charlemagne  of  the  East,  contemporary 
and  emulator  of  the  glory  of  the  emperor  of  the  Franks, 
the  hero  of  a  hundred  Arabic  poems,  wliose  dominion 
extended  from  the  borders  of  the  Indus  to  the  heart  of  tlie 
Spanish  peninsula.  He  embellished  Bagdad,  his  capital, 
with  schools  and  liospitals.  His  son  Almamon  founded 
the  Academy  of  Bagdad,  whicli  became  the  most  celebrated 
of  the  age;  likewise  spared  no  pains  to  draw  to  his  court 
the  most  illustrious  men  of  all  countries.  He  enjoined 
each  of  his  ambassador  to  purchase  all  the  writings  of  the 
philosophers  and  physicians  that  could  be  found,  and  these 
he  required  to  be  translated  into  Arabic;  his  interpreter, 
Honain,  a  Cliristian,  was  employed  at  translating  for  forty- 

*See  a  very  vigorous  denial  of  this  historical  sUtemeot  in  The  KineUenth 
Century,  October,  18M,  page  5.55. 


THE   ARABIANS   AS    PHYSICIANS.  59 

five    years,   and   received,    for   each    book    rendered   into 
Arabic,  literally  its  weight  in  gold. 

The  eclat  which  the  Moorish  caliphs  shed  upon  Spain 
from  the  tenth  to  the  thirteenth  century  is  well  known. 
The  cities  of  Cordova,  Toledo,  Seville,  and  Murcia  pos- 
sessed public  libraries  and  academies,  and  students  from  all 
parts  of  Europe  flocked  to  them  to  be  instructed  in  arts 
and  sciences;  the  library  of  Cordova  alone  embraced  more 
than  two  hundred  and  twenty-four  thousand  volumes. 
Thus  it  will  be  seen  that  the  dominion  of  mental  and 
temporal  affairs  passed  from  the  Greeks  and  Romans  to 
the  Saracens. 

Arabian  medicine  constitutes  one  of  the  most  interesting 
chapters  in  the  history  of- our -art.  An  offspring  from  Greek 
schools,  it  was  for  nearly  one  hundred  years  tlie  foster- 
mother  of  that  art,  and,  although  it  gave  rise  to  no  great 
discovery  nor  wonderful  step  in  advance  during  all  this 
period,  it  nevertheless  kept  alive  all  the  learning  of  the 
past,  and  clarified  rather  than  made  it  turbid.  In  the  sixth 
century  the  Xestorians  (followers  of  Bishop  Nestor),  having 
been  driven  out  of  Syria,  settled  in  Persia,  Mesopotamia, 
and  Arabia,  and  there  founded  schools  and  other  institutions 
such  as  they  had  liad  at  home, — schools  in  which,  beside 
the  ordinary  philosophic  studies,  medicine  received  a  share 
of  attention.  Thus  it  came  about  that  by  the  seventh 
century  Arabian  physicians  were  everywhere  known  and  in 
high  repute.  Naturally  the  basis  for  their  studies  embodied 
the  writings  of  Hippocrates,  Galen,  Oribasius,  and  Paul 
of  ^gina;  and  the  first  Arabian  works  consisted  solely 
of  translations  from  the  Greek,  first  out  of  their  Syriac 
rendering,  and  later  from  the  originals.  Indeed,  so  much 
eminence  was  finally  achieved  by  Arabian  physicians  that 
more  than  four  hundred  are  known  by  name  as  authors. 

The  first  author  deserving  of  mention  was  Baclitischna , 
of  Nestorian  stock,  celebrated  in  Jondisapur,  director  of 
the  medical  school,  and  later  physician  to  Caliph  Al-Mansor, 


60  THE    HISTORY    OF    MEDICINE. 

in  Bagdad.     Of  liis  descendants  several  became  well  known 
in  the  same  field. 

Alkindiis — this  being-  the  Latin  arrangement  of  his 
Arabic  name — came  from  a  Persian  family,  who  lived  first 
in  Basra  and  later  at  the  court  of  the  caliphs  Al-Mamum 
and  Al-Moutassem,  in  Bagdad.  He  enjoyed  a  very  high 
reputation  as  physician,  philosopher,  astronomer,  and  math- 
ematician, and  died  a.d.  873. 

Mesne,  the  first  of  his  name,  sometimes  known  as  Janus 
Damascenus,  was  director  of  the  hospital  in  Bagdad  and 
physician  to  Haroun-al-Baschid.  He  was  born  in  777, 
wrote  extensively  (since  at  least  forty  of  his  works  have 
been  catalogued),  and  died  in  857  in  Samarra. 

Serapion  the  elder,  also  sometimes  known  as  Janus 
Damascenus,  and  whose  Arabic  name  was  Serafiun,  was 
born  in  Damascus — the  exact  data  is  not  known — and  died 
some  time  prior  to  a.d.  930.  He  was  author  of  two  vol- 
umes of  aphorisms  concerning  the  practice  of  medicine, 
which  liad  at  his  time  the  greatest  repute. 

The  most  celebrated  of  the  early  Arabian  physicians 
was  Rhazes,  born  in  the  Persian  province  of  Khorassan 
A.D.  850.  According  to  the  historians  of  his  nation  he  was 
a  universal  genius,  equally  famous  in  music,  astronomy, 
mathematics,  chemistry,  and  medicine ;  he  was  surnamed 
"  The  Experienced.'^  At  the  age  of  fifty  he  was  one  of 
the  most  distinguished  professors  in  the  Academy  ot 
Bagdad,  where  students  came  from  great  distances  to  listen 
to  him.  Chosen  from  among  a  hundred  colleagues  to 
direct  the  grand  hospital  of  that  city,  he  displayed  inde- 
fatigable zeal  and  most  scholarly  learning,  even  to  his  old 
age  and  in  spite  of  loss  of  sight,  which  overtook  him  at 
the  age  of  eiglity,  when  his  reputation  was  at  its  height. 
Two  years  after  this  misfortune — i.e.,  in  932 — lie  died. 
His  generosity,  which  was  proverbial,  and  liis  compassion 
for  the  ])oor  left  him  penniless  at  the  time  of  his  death. 
Some   two  hundred   and   thirty-seven   monograplis   of   his 


RHAZES.       AVICENNA.  61 

have  been  catalogued,  though  the  greater  number  of  his 
works  are  practically  lost.  Two  treatises  on  medicine 
remain  which  afford  excellent  counsel  in  many  respects; 
among  other  matters  he  advises : — 

"  Study  carefully  the  antecedents  of  the  man  to  whose 
care  you  propose  to  confide  all  you  have  most  dear  in 
this  world, — that  is,  your  life  and  the  lives  of  your 
wife  and  children.  If  the  man  is  dissipated,  is  given  to 
frivolous  pleasures,  cultivates  witli  too  much  zeal  tlie  arts 
foreign  to  his  profession,  still  more  if  he  be  addicted  to 
wine  and  debaucliery,  refrain  from  committing  into  such 
hands  lives  so  precious." 

His  greatest  publication  Avas  Liber  Continens — ex- 
tracts compiled  from  all  authors  for  his  own  use — divided 
into  thirty-seven  books,  constituting  an  abridgment  of  the 
science  of  medicine  and  surgery  up  to  his  time ;  andj  not- 
withstanding its  imperfect  state,  this  work  was  held  in 
greatest  reverence,  and  was  a  common  source  of  knowledge 
among  Orientals  long  after  his  day. 

Haly- Abbas,  a  Persian  by  birth,  flourished  fifty  years 
after  Rhazes,  and  died  a.d.  994.  His  AJmaleJci,  in 
twenty  volumes,  constituted  a  quite  complete  system  of 
theory  and  practice  of  medicine,  which,  however,  was 
in  large  measure  taken  from  llhazes's  Continens.  It  is 
generally  regarded  as  the  best  work  of  any  of  the  phy- 
sicians of  the  Arabic  Period ;  it  is  divided  into  three  parts 
— a  book  on  Health,  a  book  on  Death,  and  a  book  of 
Signs — and  it  is  interesting  to  know  that  the  portion 
devoted  to  midwifery  and  obstetrics  was  in  the  hands  not 
only  of  the  profession,  but  also  of  the  midwives, 

Avicenna — Latinized  form  of  his  Arabic  name,  Ebn 
Sina — was  born  in  Bokhara  in  980.  From  his  earliest 
youth  he  manifested  a  remarkable  disposition  for  scientific 
study,  and  it  is  claimed  that  he  mastered  the  entire  Koran 
at  the  age  of  ten  years ;  also  that  he  devoted  his  entire 
days  and  the  greater  part  of  his  nights  to  research,  master- 


62  THE    HISTORY    OF    MEDICINE. 

ing  philosophy,  mathematics,  astronomy,  and,  later,  medi- 
cine, which  he  studied  at  the  university  at  Bagdad,  in 
which  city  his  talents  were  cliiefly  exhibited.  He  was 
received  at  court,  loaded  with  favors,  and  elevated  to 
the  dignity  of  Vizier,  but  suddenly  fell  into  disgrace,  was 
deprived  of  property,  imprisoned,  and  even  tlireatened  with 
execution.  After  two  years,  however,  he  was  restored  to 
liberty,  and  once  more  possessed  the  consideration  of  the 
public  and  the  court,  becoming  the  recipient  of  new  honors. 
Meantime  he  had  given  himself  up  to  intemperance,  by 
which  his  previously  robust  constitution  was  undermined, 
and  this,  with  excessive  labor,  brouglit  about  his  demise  at 
the  too  early  age  of  fil"ty-six,  in  the  year  1037.  He  was 
author  of  several  books,  the  chief  being  the  Canon  Medi- 
cincE,  which  remained  a  classic  for  six  centuries,  consti- 
tuting the  medical  code  of  Asia  and  Saracenic  Europe  ;  no 
author  since  Galen  had  enjoyed  so  wide  and  extensive 
authority  in  the  medical  world ;  and  in  the  various  medical 
schools  professors,  for  the  most  part,  confined  tliemselves 
to  reading  the  Canon  from  their  desks,  explaining  and 
commenting  upon  its  text.  Tlie  work  was  divided  into 
five  volumes,  of  which  the  first  two  comprised  the  prin- 
ciples of  physiology,  pathology,  hygiene,  and  therapeutics, 
arranged  to  conform  to  the  teachings  of  Aristotle  and 
Galen;  the  third  and  fourth  dealt  with  treatment;  and 
the  fifth  was  devoted  to  the  preparation  and  composition 
of  remedies.  Avicenna  appears  to  have  surpassed  in 
subtlety  both  Aristotle  and  Galen  ;  he  was  fond  of  meta- 
physical speculation,  and  his  works  were  too  much  filled 
out  with  subtleties  of  lan":uno:e  rather  than  witli  true 
science.  Autliors  of  tliis  period  were  fond  of  torturing  in 
every  way  possible  tlie  writings  which  tliey  undertook  to 
edit  or  quote  from,  and,  instead  of  devoting  themselves  to 
original  researcli,  wasted  time  in  seeking  for  vague  and 
hidden  meanings.  That  man  was  most  esteemed  as  learned 
who  could  see  the  greatest  subtlety  in  some  passage  from 


ALBUCASSIS.  63 

one  of  the  ancient  writers ;  consequently,  that  which  was 
obscure  or  unintelligible  was  deemed  the  most  sublime 
and  philosophic.  A  very  brief  study  of  the  Ganon^  for 
instance,  will  show  this,  while  in  grapliic  pictures  of  disease 
the  work  by  no  means  approaches  those  of  Areteeus  or 
Alexander  of  Tralles,  for  Avicenna  too  often  contented 
himself  with  mentioning  merely  a  list  of  symptoms  without 
indicating  in  any  way  their  progression,  characters,  or 
duration.  Undoubtedly  just  was  the  criticism  of  an 
Arabian  poet:  "His  philosophy  had  no  sound  foundation, 
and  his  medical  knowledge  availed  him  naught  for  the 
possession  of  personal  health  and  long  life." 

Albucassis  was  born  in  Zahra,  near  Cordova,  about  the 
beginning  of  the  eleventh  century,  and  is  supposed  to  have 
died  A.D.  1122,  at  the  advanced  age  of -one  hundred  and 
one.  He  was  author  of  an  abridgment,  or  compilation, 
devoted  to  the  practice  of  medicine,  the  only  novelty  of 
which  is  a  small  portion  devoted  to  surgery,  in  which  are 
described  certain  instruments.     He  says  : — 

"  I  have  detailed  briefly  the  methods  of  operations ;  I 
liave  described  all  necessary  instruments,  and  I  present 
their  forms  by  means  of  drawings ;  in  a  word,  I  have 
omitted  nothing  of  what  can  shed  light  to  the  profession. 
But  one  of  the  principal  reasons  why  it  is  so  rare 
to  meet  a  successful  surgeon  is  that  the  apprenticeship  of 
this  branch  is  very  long,  and  he  who  devotes  himself  to  it 
must  be  versed  in  the  science  of  anatomy,  of  which  Galen 
has  transmitted  us  the  knowledge.  ...  In  fine,  no 
one  should  permit  himself  to  attempt  this  difficult  art 
without  having  a  perfect  knowledge  of  anatomy  and  the 
action  of  remedies." 

Not  a  word  is  said  about  dissections,  however,  from 
which  we  conclude  that  they  were  not  tolerated  in  his  time. 
He  resorted  enthusiastically  to  the  cautery,  and  recom- 
mended it  in  spontaneous  luxations  and  the  commence- 
ment of  curvature  of  the  spine.     He  refers  particularly  to 


64  THE   HISTORY   OF   MEDICINE. 

instrumental  delivery  and  the  extraction  of  the  after-birth, 
and,  when  speaking  of  fractures  and  dislocations,  he 
remarks :  "  This  part  of  surgery  has  been  abandoned  to 
men  of  vulgar  and  uncultivated  minds,  for  which  reason  it 
has  fallen  into  undeserved  contempt." 

Avenzoar,  born  in  1113,  of  a  Spanish  family  which 
had  many  illustrious  scions,  was  instructed  in  medicine  by 
his  father,  and  ultimately  achieved  great  celebrity  through- 


FlG.  6.— AVERROES. 
(From  an  engraving  of  a  picture  by  Raffaello  in  theVatican.) 

out  Spain  and  Africa ;  for  a  time  he  lived  at  the  court  of 
the  Prince  of  Seville,  loaded  witli  honors  and  presents,  and 
finally  was  made  Vizier.  Among  other  works  he  wrote  a 
treatise  on  renal  diseases,  in  which  he  outlined  the  treat- 
ment of  calculus  and  described  an  operation  therefor.  He 
died  in  1161. 

Averroes  (as  he  is  generally  known,  though  his  Arabic 
name  was  Ehn   Unsclid)  was  born  a.d.  1166,  in  Cordova, 


AVERROES.      MAIMONIDES.  •  65 

where  his  father  held  official  position.  After  being 
grounded  in  philosophy,  mathematics,  and  other  sciences 
he  became  a  pupil  in  medicine  under  Avenzoar.  The 
greater  part  of  his  life  was  passed  in  Seville,  where  he 
was  greatly  esteemed  and  finally  knighted.  In  1195  he 
was  called  to  the  court  of  the  King  of  Spain  and  Morocco, 
in  Cordova,  where  he  received  the  highest  honors,  only, 
however,  through  some  misunderstanding,  to  be  disgraced ; 
but  he  soon  afterward  recovered  his  former  position  and 
dignities.  He  wrote  extensively  not  only  on  medicine,  but 
on  philosophy,  his  writings  taking  throughout  a  more  or 
less  dialectic  character.  He  died  in  1198,  and  from  him 
descended  a  number  of  physicians  who  achieved  more  or 
less  reputation. 

Maimonides,  the  Jew,  was  born  in  Cordova,  a.d.  1135. 
He  early  devoted  himself  to  the  Talmud,  and  in  his  ex- 
tended travels  visited  Jerusalem ;  he  even  founded  a  school 
of  philosophy  in  the  East,  which,  however,  had  only  a 
brief  existence.  He  died  in  1204.  He  ranked  higher  in 
philosophy  than  in  medical  art,  and  seems  to  have  been 
imbued  with  the  methods  of  his  teacher,  Averroes,  and  is 
generally  regarded  as  a  theorist  rather  than  as  a  practical 
physician,  although  he  wrote  more  or  less  on  medical 
topics,  and  is  particularly  remembered  for  an  essay  upon 
poisons.  He  was  about  the  last  of  the  Arabians  who 
deserves  special  mention. 

During  the  period  which  was  nearing  its  close  at  the 
time  of  the  death  of  Maimonides,  the  Arabs  embraced 
with  much  ardor  the  study  of  medicine,  and  translated 
into  their  language  nearly  all  the  treasures  that  had  been 
amassed  by  the  Greeks ;  indeed,  tlie  preservation  of  many 
of  the  great  writings  which  would  otherwise  have  been 
lost  is  due  solely  to  this  fact.  Strange  to  say,  however, 
the  Arabians  neglected  Latin  authors,  and  apparently  pos- 
sessed no  knowledge  of  Celsus  or  Ccelius  Aurelianus.  As 
religious     prejudices    prohibited    dissections,    they    were 


66  THE    HISTORY   OF   MEDICINE. 

obliged  to  rely  solely  upon  the  anatomical  descriptions  of 
Galen,  and  succeeded  in  increasing  the  errors  of  the  orig- 
inal by  inaccurate  translations.  So  far  as  originality  of 
observation  goes,  the  Arabians  were  in  most  respects 
behind  the  Greeks ;  nevertheless,  they  were  the  first  to 
differentiate  eruptive  fevers,  to  which  the  latter  paid  little 
or  no  attention.  The  Arabian  school  also  supplied  the 
knowledge  of  purgatives,  such  as  cassia  and  manna,  which 
replaced  the  drastics  employed  by  the  ancients ;  also  the 
mode  of  preparation  of  syrups,  tinctures,  distilled  waters, 
pomades,  and  plasters. 

While  the  Arabians  were  gradually  rising  by  their 
power,  intelligence,  and  renown,  the  Greeks  were  de- 
clining in  inverse  ratio;  the  genius,  courage,  and  ancient 
virtues  of  the  latter  grew  weaker  and  weaker,  until 
they  seemed  on  the  verge  of  extinction.  In  the  med- 
ical history  of  these  centuries,  in  all  Europe  not  under 
Moslem  rule,  there  was  but  one  man  entitled  to  mention 
as  an  author  in  medicine, — viz.,  John  Actuarius,  the  son 
of  one  Zacharia.  He  lived  at  the  close  of  the  thirteenth 
and  the  beginning  of  the  fourteenth  century ;  was  employed 
at  Constantinople,  his  surname  being  the  honorary  title 
of  the  court-physicians.  He  is  more  commonly  known  as 
Zacharia.  Of  his  life  we  know  little,  save  that  he  wrote 
several  volumes,  for  the  most  part  abridgments  or  com- 
mentaries on  the  doctrine  of  Galen.  He  laid  great  stress 
on  the  theory  of  critical  days,  and  sustained  his  views  by 
astronomical  hypotheses  most  ingeniously  combined.  His 
was  the  first  Greek  work  in  which  were  mentioned  the 
remedies  introduced  by  the  Arabians,  yet  he  has  not  a 
word  to  say  of  variola,  measles,  spina  ventosa,  and  other 
aff"ections  fully  described  by  Arabic  authors.  He  held 
remarkable  views  concerning  the  nature  of  man,  whom  he 
supposed  to  be  formed  by  the  union  of  two  contrary  sub- 
stances,— the  soul  and  the  body ;  described  somewhat 
elaborately  an  imaginary  plexus  of  veins  connected  with 


DECADENCE  OF  THE  EASTERN  EMPIRE.         67 

tlie  digestive  organs,  through  which  the  animal  spirits 
were  elaborated  and  purified;  also,  and  quite  methodically, 
for  his  age,  he  explained  the  functions  of  the  animal 
economy  and  the  etiology  of  disease. 

While  the  clouds  that  befogged  the  study  of  medicine 
in  the  Empire  of  the  East  thus  grew  heavier  and  heavier, 
we  must  not  be  blind  to  the  melancholy  spectacle  concern- 
ing the  provinces  composing  the  Empire  of  the  West. 
Barbarians  in  swarms,  from  the  forests  of  Germany  and 
Scandinavia,  had  swept  its  various  portions,  pillaging, 
destroying,  and  reducing  to  slavery  its  inhabitants.  In 
southern  Europe  everything  was  changed.  Each  genera- 
tion witnessed  some  new  and  unheard-of  invader,  who 
demanded  his  share  of  booty  and  renown  and  left  a  track 
of  desolation  behind  him.  There  was  a  brief  period  of 
order  when  Charlemagne  reunited  under  one  dominion 
these  divers  races  and  seemed  to  have  resuscitated  the 
Western  Empire ;  but  no  sooner  was  he  dead  than  its 
elements,  being  devoid  of  affinity,  broke  apart.  Former 
vassals,  no  longer  restrained  by  the  firm  hand  of  the 
emperor,  made  common  warfare  against  his  successors  and 
against  each  other,  and  for  several  ages  there  was  nothing 
but  a  succession  of  wars  and  invasions.  Feudalism  gave 
some  sort  of  character  to  this  military  anarchy  by  affording 
repose  and,  in  a  measure,  security  for  those  who  had 
hitherto  been  trampled  under  foot ;  but  learning  and  the 
sciences  fell  into  complete  neglect,  and  it  was  with  great 
difficulty  that  a  very  small  number  of  men  found  within 
the  pale  of  the  church  a  limited  protection  that  enabled 
them  to  devote  themselves  to  the  study  of  medicine  and 
ecclesiastical  law.  Near  the  end  of  the  eleventh  century, 
however,  the  enthusiasm  of  the  crusades  whetted  anew 
the  turbulent  appetite  of  the  Christian  barons,  and  led 
these  lords  of  western  Europe,  with  their  belligerent 
spirits,  to  the  East,  as  a  result  of  which  people  hitherto 
oppressed  could  breathe  more  freely.     A  few  States  recov- 


68  THE   HISTORY    OF   MEDICINE. 

ered  their  independence ;  some  semblance  of  law  was 
established ;  municipal  institutions  were  organized,  and 
establishments  consecrated  to  public  use  were  founded  and 
multiplied ;  finally,  in  the  course  of  the  thirteenth  and 
fourteenth  centuries,  the  cloud  which  covered  the  face  of 
Roman  Catholic  Europe  was  in  some  measure  dispersed, 
and  men  of  talent  and  even  genius  began  to  appear  upon 
the  scene ;  everything  about  them  being  so  obscure,  they 
shone  like  stars  in  the  firmament.  In  letters,  for  instance, 
there  were  Dante,  Petrarch,  Boccaccio ;  in  mathematics, 
Leonard,  of  Pisa,  the  first  in  Europe  to  understand  and 
employ  figures  and  algebraic  characters,  although  Cuvier 
has  claimed  this  distinction  for  Gerbert,  a  Benedictine 
monk  of  the  tenth  century,  who  subsequently  became  Pope 
Sylvester  II.  At  this  time,  although  in  scholastic  estima- 
tion medicine,  theology,  and  philosophy  alone  were  fit  to 
entertain  the  human  mind,  the  natural  sciences  were  not 
without  occasional  representatives.  Roger  Bacon  was 
three  centuries  in  advance  of  scientific  reform,  and  en- 
deavored to  introduce  experimental  philosophy,  and  so 
fully  convinced  some  of  his  auditors  that  they  subscribed 
£2000  sterling  to  provide  for  the  expense  of  his  experi- 
ments; this  was  money  most  happily  employed,  since  it 
made  possible  a  number  of  important  discoveries.  It  is 
said  that  Bacon  knew  the  properties  of  convex  and  concave 
lenses,  and  was  the  first  to  conceive  of  the  microscope  and 
telescope;  his  astronomical  knowledge  led  him  to  demand 
a  reform  in  the  calendar,  which  Gregory  XIII  carried  out 
three  centuries  later ;  he  had  knowledge  of  gunpowder 
and  its  effects,  and  was,  in  fact,  the  wizard  of  his  day;  but 
his  boldness  and  originality  drew  upon  him  the  enmity 
of  tlie  church,  by  which  he  was  persecuted  and  finally 
condemned  to  imprisonment  for  life  upon  a  diet  of 
bread  and  water,  altliough  he  was  ultimately  released, 
in  1266,  by  Pope  Clement  lY.  He  wrote  extensively, 
but  only  fragments  of  his  works  exist,  since    the   friars 


CONDITIONS   IN    THE    EMPIRE   OF   THE    WEST.  69 

believed  .them  tainted  with  witchcraft  and  prevented  their 
pubUcation.  ;  . 

Before  and  during  the  time  of  Roger  Bacon  the  philos- 
ophers were  divided  into  two  parties,  which  engaged  in 
very  unseemly  and  unphilosophic  strife.  One  was  termed 
the  Realist^  and  believed,  with  Plato,  that  ideas  are  self- 
existent  and  independent  of  tlie  mind, — in  other  words, 
veritable  entities;  the  other,  the  Nominalist,  held,  with 
Aristotle,  that  general  ideas  are  pure  abstractions  formed  by 
the  mind  with  the  aid  of  sensations  received  from  without, 
without  which  they  could  never  exist, — that  is,  if  a  being- 
could  be  imagined  witliout  sensibilities  and  the  power  of 
sensation,  such  being  would  be  destitute  of  ideas.  These 
two  parties  kept  up  a  very  active  warfare,  and  enlisted 
the  aid  of  both  civil  and  ecclesiastical  authorities,  the 
result  being  persecution  of  each  other,  and  that  general 
unsatisfactory  conflict  into  which  theology  and  meta- 
physical speculation  always  force  those  who  indulge  in 
them. 

Now,  regarding  the  condition  of  medical  aft'airs  in  the 
Empire  of  the  West:  Down  to  the  seventh  century,  in 
Bome,  there  were  court-archiaters  who  were  attached  to  the 
retinues  of  tlie  nobles,  and  in  each  large  city  popular  archi- 
aters  formed  a  college  charged  with  sanitary  matters,  the 
instruction  and  examination  of  candidates,  and  gratuitous 
services  to  the  poor.  Although  there  is  little  definite  in- 
formation available,  it  is  probable  that  after  the  ruin  of 
Alexandria  much  the  same  medical  organization  obtained 
in  those  provinces  as  continued  under  the  Greek  Empire  at 
Constantinople.  Under  Arab  sway  we  know  very  little  of 
what  rules  or  regulations  governed  instruction  in  medicine 
and  its  practice ;  and,  so  soon  as  one  of  these  countries  fell 
under  the  rule  of  the  Turks,  all  scientific  institutions  seem 
to  have  decayed  or  been  discontinued, — or,  as  Renouard 
states  it:  "If  we  may  judge  by  what  still  exists  to-day  in 
this  luifortunate  country  (Turkey),  consumed  by  the  power 


7C  THE    HISTORY   OF   MEDICINE. 

of  ignorance  and  despotism,  the  most  complete,  anarchy 
followed  all  older  organizations." 

In  soutliern  Europe,  however,  things  had  not  gone  on 
quite  so  badly,  although  at  first  barbarous  invasion  caused 
everywhere  disorder  and  confusion,  and  the  Christian  States 
of  the  Western  Empire  yet  presented  after  three  or  four 
centuries  a  chaotic  condition  of  affairs.  The  ecclesiastical 
schools,  which  were  under  the  care  of  the  church,  still  pur- 
sued courses  of  literary  and  scientific  instruction;  in  the 
time  of  Charlemagne,  for  instance,  the  colleges  of  the 
cathedrals,  and  even  some  of  the  monasteries,  taught  medi- 
cine in  a  very  limited  way  under  the  name  of  ])hysics. 
Thus  all  the  liberal  professions — that  of  medicine  included 
— fell  under  the  domination  of  the  clergy,  and  priests, 
abbots,  and  bishops  became  court-physicians.  The  monks 
of  Mount  Cassin,  of  the  order  of  St.  Benoit,  enjoyed  for  a 
long  time  a  great  reputation  for  medical  skill ;  and  among 
these  in  the  tenth  century  was  an  abbot  named  Berthier 
Didier,  who  became  Pope  Victor  III  toward  the  close  of 
the  eleventh  century,  and  one  Constantino,  surnamed  the 
African.  Of  the  ecclesiastics  who  from  the  ninth  to  the 
eleventh  century  were  distinguished  by  the  knowledge  of 
medicine,  there  were  Hugues,  abbot  of  St.  Denis,  pliysician 
to  the  King  of  France;  Didon,  abbot  of  Sens;  Sigoal,  abbot 
of  Epernay;  Archbishop  Milo,  etc.  Even  several  religious 
orders  of  women  undertook,  to  a  certain  extent,  the  practice 
of  medicine,  and  Hildegarde,  who  was  abbess  of  the  con- 
vent of  Rupertsburg,  near  Bingen,  is  credited  with  having 
written  a  treatise  on  Materia  Medica. 

From  the  ninth  to  the  thirteenth  century  the  Jews 
shared  with  the  clergy  tlie  monopoly  of  the  healing  art. 
Many  of  these  studied  under  Arabian  physicians,  and, 
though  the  canons  of  the  cliurch  forbade  them  to  in  any 
way  minister  to  the  ailments  of  Christians,  they  wexe  still 
called  upon  in  time  of  need,  and  even  in  many  instances  had 
access  to  the  palaces  of  archbishops,  cardinals,  and  popes. 


INFLUENCE    OF -THE    NORTHERN    INVADERS.  71 

The  education  of  Christian  priests  and  infidel  prac- 
titioners embraced  really  very  little,  and  consisted,  for  the 
most  part,  of  knowledge  of  a  few  symptoms  and  possession 
of  a  few  receipts ;  books  were  excessively  rare  and  ex- 
pensive, capable  teachers  lacking,  and  a  good  medical  edu- 
cation out  of  the  question.  There  was  no  law  nor  public 
regulation  wliich  concerned  the  practice  of  medicine,  and 
any  who  desired  could  enter  upon  it;  while  besides  the 
priests  and  the  Jews — which  latter  stood  at  the  top  of  the 
scale — there  was  a  multitude  of  charlatans  of  the  lowest 
order,  such  as  barbers,  keepers  of  baths,  and  even  a  few 
women.  The  morality  of  this  vulgar  herd  was  on  a  level 
with  its  knowledge.  I  have  said  the  practice  of  medicine 
was  not  regulated  by  law,  yet  Theodoric,  King  of  the 
Visigoths,  enacted  a  statute  that  no  physician  sliould  bleed 
a  woman  of  noble  birth  witliout  the  assistance  of  a  relative 
or  domestic ;  that  if  a  physician  in  treating  a  patient  or 
dr  ssing  a  wound  happened  to  harm  a  gentleman  he 
should  pay  a  forfeit  of  one  hundred  sous,  and  if  the  patient 
died  from  the  operation  he  should  be  handed  over  to  the 
relatives  of  the  deceased,  who  could  do  with  him  whatever 
they  pleased ;  while  if  he  crippled  or  caused  the  death  of 
a  serf,  he  was  to  be  held  accountable  only  for  the  loss,  and 
compelled  to  supply  another.  This  remained  in  force  from 
the  sixth  to  the  twelfth  century,  and  was  made  to  apply 
chiefly  to  the  practice  of  surgery,  which  had  been  aban- 
doned to  individuals  of  the  lowest  condition.  The  practice 
of  internal  medicine  was,  for  the  principal  part,  the  privilege 
of  the  clergy,  and  it  is  not  likely  the  secular  power  ever 
expected  that  one  protected  with  the  title  of  priest  should 
be  handed  over  to  the  relatives  of  the  dead.  It  further- 
more appears  that  the  practice  of  medicine  as  divorced 
from  surgery  led  to  such  irregularities  in  the  manners  and 
conduct  of  the  clergy  that  from  the  twelfth  century  popes 
and  councils  of  the  church  repeatedly  forbade  the  medical 
art  to  those  in  holv  orders  or  under  vows ;  but  that  this 


72  THE    HISTORY   OF   MEDICINE. 

prohibition  was  often  violated  is  shown  by  the  frequent 
reiteration  of  inhibitory  laws.  During  the  twelfth  century 
the  secular  authority  was  also  affected  by  abuses.  Roger, 
founder  of  the  kingdom  of  Sicily,  one  of  the  first  Christian 
princes  of  the  Middle  Ages,  gave  special  attention  thereto, 
and  in  1140  proclaimed  that  every  one  who  wished  to  prac- 
tice medicine  must  present  himself  before  a  magistrate 
and  obtain  authorization,  under  pain  of  imprisonment  and 
confiscation  of  goods.  Other  sovereigns  followed  this  ex- 
ample, and  regulating  ordinances  were  gradually  estab- 
lished, which  ultimately  led  to  the  institution  of  medical 
faculties  and  university  degrees. 

During  the  Middle  Ages,  in  the  Empire  of  the  West, 
arose  the  School  of  Salernum,  which  became  so  celebrated 
that,  like  that  of  Alexandria,  it  deserves  special  mention. 
The  modem  city  of  Salerno  is  situated  on  the  Gulf  of 
Salerno,  about  thirty  miles  s-outheast  of  the  city  of  Naples, 
with  a  population  of  but  a  few  thousand  souls.  The 
ancient  city  stood  upon  a  height  in  the  rear  of  the  present 
town,  where  the  ruins  of  its  mediaeval  citadel  are  still  to  be 
seen.  It  first  appeared  in  history  194  B.C.,  when  a  Roman 
colony  was  founded,  was  a  municipal  town  of  importance, 
and  appears  even  at  this  early  day  to  have  been  a  health  re- 
sort, since  Horace  informs  us  he  had  been  advised  to  substi- 
tute its  cool  baths  for  the  warm  ones  of  Baiae.  During  the 
stormy  centuries  following  the  downfall  of  the  Western 
Empire,  Salerno  successively  submitted  to  the  sway  of  the 
Goths,  Lombards,  Franks,  Saracens,  and  Greeks,  as  the 
vicissitudes  of  war  compelled.  Under  the  Lombards  it 
became  the  residence  of  the  Duke  of  Beneventum,  and, 
in  1075,  when  taken  by  Robert  Guiscard  of  Normandy,  it 
fell  to  the  crown  of  Naples,  in  consequence  of  which  in  the 
fourteenth  century,  the  heir  apparent  of  this  kingdom  took 
the  title  of  Prince  of  Salernum. 

During  the  Middle  Ages  here  flourished  a  medical 
erlinol.  important  not  alone  because  of  its  celebrity  at  the 


FOUNDATION    OF   THE    SCHOOL    OF    SALEKNUJVI.  73 

time,  but  for  its  effect  upon  the  medical  history  of  the 
future.  Its  origin  is  obscure,  though  it  has  been  ascribed 
to  Charlemagne  in  802 ;  again,  its  founding  has  been  lield 
to  be  the  work  of  fugitives  from  Alexandria  when  that  city 
was  captured  by  the  Saracens,  640  a.d.  ;  some  attribute  it 
to  the  Benedictine  order  of  monks,  others  to  Saracens,  etc. 
Tiie  foundation  by  Alexandrian  fugitives  is  probably  con- 
jectural, yet  it  must  be  admitted  there  is  some  evidence  of 
knowledge  of  Arabian  medicine  in  Salernum  as  early  as 
this.  Be  the  origin  what  it  may,  it  is  certain  that  the  Ben- 
edictine monks  exercised  a  very  important  influence  upon 
this  school,  and  there  is  considerable  reason  to  think  that  it 
was  really  originated  by  them.  Their  monastery  of  Monte 
Casino  was  located  about  fifty  miles  the  other  side  of  Na- 
ples, occupying  the  site  of  an  ancient  temple  of  Apollo ; 
the  rules  of  the  order  enjoined  the  care  of  the  sick  and 
treatment  by  prayer,  and  St.  Benedict  himself  was  credited 
with  performing  miraculous  cures.  The  rules  which  for- 
bade public  instruction  were  gradually  discarded,  for  in  the 
ninth  century  Abbot  Bertharius  wrote  two  books  on  the 
art  of  healing,  and  by  the  tenth  century  Monte  Casino  had 
acquired  great  reputation  as  a  medical  school,  and  was 
sought  by  medically-inclined  monks  from  all  quarters.  A 
little  later  (1022)  King  Henry  II,  of  Bavaria,  Emperor  of 
Germany,  is  said  to  have  been  cut  for  stone  by  St.  Benedict 
himself,  who  appeared  in  ghostly  form  and  operated  with 
such  skill  that  on  awaking  the  royal  patient  found  the 
calculus  in  his  hand,  and  only  the  cicatrix  of  the  wound 
through  which  it  had  been  removed.  Of  course,  the 
grateful  emperor  could  do  no  less  than  richly  endow  the 
monastery,  and  bestow  upon  it  additional  privileges. 

Desiderius,  the  Benedictine  abbot  from  1058  to  1086, 
and  in  the  eleventh  century  promoted  to  the  papal  chair 
under  the  title  of  Victor  III,  was  distinguished  for  his 
attainments  in  medicine  and  in  music,  and  founded  a  new 
hospital  in  connection  with  the  monastery ;  he  also  com- 


74  THE    HISTORY    OF    MEDICINE. 

posed  four  books  detailing  the  miiacidous  cures  wrought 
by  his  patron  saint.  It  was  really  within  this  monastery 
that  Constantino  the  African,  one  of  the  most  learned  men 
and  the  most  famous  Christian  physician  of  his  time,  com- 
piled his  numerous  medical  treatises. 

About  Constantino  there  is  much  of  romance.  He  was 
born  in  Carthage  in  1018  and  died  in  1085.  He  visited 
all  the  prominent  schools  of  his  day  in  Egypt,  Bagdad, 
Babylon,  and  even  India,  and  for  thirty-nine  years  pursued 
the  various  branches  of  knowledge  away  from  home.  Re- 
turning to  Carthage,  misunderstood  and  feared,  he  was 
accused  of  practicing  sorcery  and  compelled  to  fly  to  save 
his  life.  Disguised  as  a  beggar  he  escaped  to  Salernum, 
which  had  been  recently  captured  by  Robert  Guiscard,  and 
on  the  recommendation  of  some  royal  visitor,  who  had 
known  him  at  another  court,  he  was  made  private  sec- 
retary to  Guiscard.  His  new  duties  soon  became  irkscme, 
however,  and  he  retired  to  a  cloister  to  devote  himself  to 
literary  labors.  These,  for  the  most  part,  were  translations 
of  Greek  and  Arabic  writings,  often  made  verbatim  and 
without  credit.  Whatever  may  be  said  about  this  lack  of 
honesty,  and  the  barbaric  nature  of  his  Latin,  ^credit  must 
be  given  him  for  reviving  the  study  of  Hippocrates  and 
Galen  in  France ;  and  he  is  generally  credited  with  being 
the  first  to  introduce  into  Europe  knowledge  of  Arabian 
medicine. 

From  Monte  Casino  the  Benedictines  at  an  early  day 
spread  to  Salernum,  where,  by  the  middle  of  the  tenth 
century,  three  monasteries  were  established,  in  all  of  which 
were  kept  holy  relics.  It  now  appears  that,  although  there 
may  have  been  some  previous  institution  of  learning  at 
this  point,  and  possibly  even  medical  teachers,  the  real 
organization  of  a  regular  school  of  medicine  was  due  to  the 
Benedictines.  In  the  annals  of  Naples  of  the  middle  of  the 
ninth  century  the  names  of  Salernian  physicians  are  men- 
tioned ;  and  it  is  known  tliat  toward  the  close  of  the  tenth 


VISITS    OF    THE    CRUSADERS    TO    SALERNUM.  75 

century  Archbishop  Verdun  visited  Salerpum  for  reUef 
from  vesical  calculus,  and  there  died. 

The  earliest  medical  writings  of  this  school  which  have 
been  preserved  are  found  in  the  Compendium  Salernitanum, 
discovered  in  manuscript  form  in  1837;  and  among  the 
more  prominent  authors  quoted  are :  Petronius,  who  wrote 
about  1035;  Gariopontus,  who  wrote  about  1040;  Bar- 
tholomaeus,  Ferrarius,  and  Afflacius, — the  latter  a  disciple 
of  Con  Stan  tins  African  us. 

The  preaching  of  Peter  tlie  Hermit,  which  marked  the 
close  of  the  eleventh  century,  was  followed  by  an  outburst 
of  crusading  enthusiasm  that  quickly  converted  Europe  into 
a  vast  camp,  and  Salernum,  being  situated  upon  the  high- 
road to  the  East,  was  benefited  in  no  small  degree  and  its 
reputation  as  a  medical  school  materially  enhanced ;  like- 
wise its  teachers  gained  in  experience  as  regards  mili- 
tary surgery.  In  this  way  it  became  a  favorite  resort  for 
crusaders  when  disabled,  wounded,  or  diseased.  Robert 
of  Normandy,  son  of  the  conqueror,  returning  from  the 
Holy  Land,  remained  here  for  some  time  witli  a  poisoned 
wound  in  the  arm,  received  in  1097  at  the  siege  of  Jeru- 
salem, and  it  was  decided  it  could  be  healed  only  by  suck- 
ing out  the  poison,  a  process  deemed  dangerous  to  the 
operator.  History  declares  that  Robert's  wife,  daughter  of 
Goeftrey,  Earl  of  Conversana,  being  denied  permission,  took 
advantage  of  her  husband's  unconsciousness  during  sleep  to 
withdraw  the  poison,  when  the  wound  speedily  healed.  At 
the  time  of  the  departure  of  Ro!)ert,  hastened  by  the  death 
of  his  brother  William,  John  of  Milan,  the  then  chief  of  the 
medical  school,  presented  him  with  the  famous  Regimen 
Sanitatls  Salerni,  said  to  have  been  composed  largely  for 
Robert's  benefit.  This  was  a  Latin  poem  that  enjoyed 
most  unexampled  popularity  for  many  generations,  and 
was  the  2mde  mecum  of  well-educated  physicians  for  cent- 
uries. It  is  said  to  have  passed  through  two  hundred  and 
forty  different  editions,  and  that  more  than  one  hundred 


76  THE    HISTORY    OF   MEDICINE. 

manuscript  copies  are  to-day  to  be  found  in  various  Euro- 
pean libraries.  The  latest  English  version  was  published 
by  Professor  Ordronaux  in  1871.  A  sample  is  here  sub- 
mitted : — 

*'  Salerno's  school  in  conclave  high  unites 
To  counsel  England's  king,  and  thus  indites : 
If  thou  to  health  and  vigor  would'st  attain, 
Shun  mighty  cares  ;  all  anger  deem  profane  ; 
From  hea%y  suppers  and  much  wine  al^stain  ; 
Nor  trivial  count  it  after  pompous  fare 
To  rise  from  table  and  to  take  the  air. 
Shun  idle  noonday  slumbers,  nor  delay 
The  urgent  calls  of  nature  to  obey. 
These  rules  if  thou  wilt  follow  to  the  end, 
Tliy  life  to  greater  length  thou  may'st  extend." 

During  the  twelftli  and  tliirteenth  centuries  the  glory 
of  the  School  of  Salerno  reached  its  zenith ;  it  was  the 
most  famous  school  of  medicine  in  Europe,  and  was  fostered 
by  various  kings.  The  celebrated  Jew,  Benjamin  of 
Tudela,  traveling  from  Spain  to  India,  visited  Salernum 
in  1164,  and  called  it  the  "principal  university  of  Chris- 
tendom." Early  in  the  twelfth  century  flourished  Cophon, 
Archimatheus,  and  Nicholas,  surnamed  Prsepositus,  all  of 
whom  were  distinguished  teachers.  The  latter  published 
a  work  known  as  Antidotarium^  which  was  for  several 
centuries  the  standard  pliarmacopoeia,  and  which  con- 
tained a  table  of  weights  that  corresponded  very  closely 
to  those  of  the  modern  apothecary.  The  younger 
Cophon,  who  lias  been  confounded  with  his  father  (as 
both  seem  to  have  written  extensively),  wrote  two  trea- 
tises,— one  on  the  anatomy  of  the  liog,  the  otlier  entitled 
Ars  Medendi.  The  first  is  interesting  as  the  only 
anatomical  treatise  of  this  school  which  has  been  pre- 
served, and  is  an  index  of  tlie  degradation  of  anatomical 
science  of  tliat  time. 

The  names  of  John  and  Matthew  Platearius  are  of 
frequent  occurrence  in  the  records  of  this  school,  and  have 
given  rise  to  considerable  confusion;  the  former  is  supposed 


EARLY  SALERNIAN  SCHOLARS.  77 

to  have  been  the  husband  of  Trotula,  a  female  physician, 
of  whom  I  sliall  have  more  to  say  later. 

Bernard  the  Provincial,  wlio  seems  to  have  escaped 
the  notice  of  most  liistorians,  wrote  about  1155,  and  his 
commentary  offers  much  interesting  information  concerning 
the  therapeutics  of  the  day  ;  he  formulated  a  large  number 
of  recipes  to  enable  the  sick  to  escape  the  omnipotence  of 
the  apothecaries,  and  recommended  wine  for  the  delicate 
stomachs  of  the  more  exalted  of  the  clergy,  and,  inasmuch 
as  these  stomachs  did  not  bear  medicine  well,  he  directed, 
in  accordance  witli  the  practice  of  Archbishop  ^fanus,  that 
emetics  should  be  prescribed  after  meals,  when  their  action 
is  less  injurious  and  more  agreeable ;  he  advised  young 
men  and  women  tormented  with  love  which  they  could  not 
gratify  to  tie  their  hands  behind  their  backs  and  drink 
water  from  a  vessel  in  which  a  red-hot  iron  had  been 
cooled.  Indeed,  his  work  is  full  of  curious  information 
and  advice,  and  is  not  without  therapeutic  interest. 

A  name  which  figures  largely  in  the  history  of  this 
school  is  that  of  Magister  Salernus,  about  which  there  is 
great  uncertainty ;  it  is  not  positively  known  whether  this 
refers  to  a  particular  person  or  is  a  generic  name  covering 
various  individuals.  The  name  has  been  mentioned  as  that 
of  one  of  the  four  reputed  founders  of  the  school ;  it  is 
positive  that  there  are  certain  treatises  which  bear  this 
name,  which  give  an  appearance  of  authenticity  to  it  as  an 
individual  title. 

In  the  latter  half  of  the  twelfth  century  lived  John  of 
St.  Paul,  one  of  the  teachers  of  Gilbert  the  Englishman ; 
also  Musandinus,  who  left  a  curious  treatise  on  dietetics ; 
and  Urso,  who  wrote  on  the  pulse  and  on  the  urine.  Here 
in  1190  resided  and  studied  a  certain  Alcadinus,  from 
Syracuse,  whose  knowledge  of  philosophy  and  medicine  was 
such  that  he  acquired  great  reputation,  and  was  made  a 
professor;  he  even  composed  Latin  medical  poems. 

Just  at  the  close  of  tliis  century  flourished  JEgidius,  who 


78  THE   HISTORY   OF   MEDICINE. 

studied  at  Salenuim,  and  also  at  Montpellier,  where  a 
school  of  medicine  had  been  founded  in  1180;  he  was 
physician  to  Pliilip  Augustus,  of  France,  and  became  pro- 
fessor in  the  University  of  Paris.  Three  treatises,  all  in 
Latin  hexameter,  are  ascribed  to  him,  A  contemporary 
was  Joliannes  Rogerius,  of  P^alermc,  a  graduate  of -Saler- 
num  and  author  of  several  works. 

Early  in  the  thirteenth  century  flourished  Roger  of 
Parma,  one  of  the  most  distinguished  of  the  alumni  of  this 
school  and  the  earliest  pioneer  in  modern  surgery;  his 
w  ork  on  this  topic,  familiarly  known  as  Rogeriana^  enjoyed 
the  greatest  reputation  in  its  day,  and  was  for  a  long  time 
the  surgical  text-book  of  Italy;  his  predilection  for  poultices 
and  moist  dressings  in  the  treatment  of  wounds,  abscesses, 
and  ulcers  became,  in  the  hands  of  his  successors,  the  dis- 
tinguishing feature  of  the  surgery  of  Salernum  in  opposition 
to  the  school  at  Bologna,  where  Hugo  Di  Lucca  and  Theo- 
doric  (his  great  rival)  contended  for  the  superiority  of  the 
dry  treatment.  Roger  was  also  the  first  to  use  the  term 
seton,  and  to  give  practical  demonstration  to  this  means  of 
derivation. 

Roland  of  Parma,  a  pupil  of  Roger,  and  a  surgeon  of 
great  distinction,  became  professor  at  Bologna,  and  wrote  a 
treatise  on  surgery,  which  was,  for  the  most  part,  a  com- 
mentary on  the  works  of  his  master.  The  treatise  of  Roger 
and  that  of  Roland  furnished  the  basis  for  a  work  entitled 
The  Treatise  of  the  Four  Masters^  supposed  to  have  been 
written  about  1270,  and  manuscripts  of  which  have  been 
long  known  in  various  European  libraries.  It  is  divided 
into  four  books,  displays  no  little  surgical  ability,  and  from 
its  title  would  appear  to  have  been  the  joint  composition  of 
four  teachers;  indeed,  it  was  long  attributed  to  Archima- 
theus,  Platearius,  Petro  Cellus,  and  Affiacius,  though  it  is 
now  pretty  generally  understood  to  be  the  product  of  but 
a  single  pen  and  its  author  most  likely  a  Frenchman.  The 
ascription  of  authorship  to  four  masters  was  probably  for 


WOMEN    IN    THE    SALERNIAN    SCHOOL.  79 

the  purpose  of  increasing  its  weiglit  and  authority,  and  it 
constituted  a  reliable  exposition  of  the  surgery  of  Salernum 
in  its  day.  It  is  quoted  quite  freely  by  Guy  de  Chauliac, 
who  was  the  restorer  of  French  surgery  in  the  fourteenth 
century,  and  occasionally  by  later  writers. 

Another  of  the  distinguished  Salernian  physicians  of 
the  thirteenth  century,  one  highly  esteemed  by  Frederick 
II,  was  John  of  Procida,  who  also  was  active  in  producing 
— if  not  the  real  author  of — the  massacre  of  the  Sicilian 
Vespers,  a.d.  1282.  In  a  dispute  concerning  the  question 
of  the  two  Sicihes  he  embraced  the  cause  of  Prince  Man- 
fred, for  which  he  was  banished  by  Charles  of  Anjou,  and 
took  refuge  at  the  court  of  Peter  III,  of  Arragon,  by  whom 
ne  was  created  a  baron ;  and  he  was  influential  in  per- 
suading the  latter  to  assert  his  claim  to  the  throne  of 
Sicily.  By  various  intrigues  at  different  courts  he  suc- 
ceeded in  organizing  an  alliance,  which  betrayed  its 
existence  in  this  massacre,  and  finally  resulted  in  the 
overthrow  of  the  French  in  Sicily  and  the  transfer  of 
the  island  to  the  crown  of  Spain.  He  was  author  of  at 
least  two  treatises  devoted  to  medicine  and  philosophy. 

Other  writers  of  the  School  of  Salernum  were :  a 
learned  Jew  of  Agrigentum  known  as  "  Farragus," 
Matthew  Sylvaticus,  Graphseus,  and  Cappola.  About 
the  middle  of  the  fifteenth  century  flourished  Saladino, 
famous  as  an  authority  on  materia  medica. 

It  is  of  no  small  interest  that  now,  for  the  first  time 
in  history,  women  began  to  figure  somewhat  prominently 
as  writers,  practitioners,  and  even  teachers  of  medicine. 
About  the  middle  of  the  eleventh  century  appeared  a 
work,  entitled  De  MnUerium  Passionibus,  attributed  to  the 
before-mentioned  Trotula,  wife  of  Jolni  Platearius,  which 
has  descended  even  to  these  days.  There  is  nothing  in 
the  work  to  indicate  the  name  or  sex  of  the  author,  who 
is  invariably  spoken  of  in  the  third  person;  consequently 
Trotula's   connection    therewith  has  often  been  disputed. 


80  THE   HISTORY   OF   MEDICINE. 

It  mentions  a  certain  "  aqua  ynirabilis"  composed  largely 
of  brandy,  which  spirit  is  said  to  have  first  been  employed 
medicinally  by  Thaddeus  of  Florence,  who  died  in  1295; 
there  is  also  an  account  of  a  patient  who  wore  spectacles ! 
The  diseases  of  women  and  children  are  also  largely  dealt 
with.  The  work  is  undoubtedly  an  anonymous  production 
of  the  eleventh  century,  disfigured  by  additions  of  a  later 
day,  and  ascribed  to  Trotula,  perhaps,  because  of  the  celeb- 
rity that  attached  to  her ;  at  all  events,  it  is  the  earliest 
work  ascribed  to  a  female  physician,  and  thus  possesses 
special  claims  to  interest. 

Later  we  read  of  Sichelguada,  wife  of  Robert  Guiscard 
and  a  graduate  of  Salernum,  who  endeavored  to  poison  her 
step-son,  Bohemond,  in  order  to  secure  the  succession  of 
her  own  child.  This  infamous  plot  was  furthered  by  some 
of  the  Salernian  physicians,  and  thwarted  only  by  the 
prompt  action  of  Guiscard,  who  swore  he  would  slay  his 
wife  with  his  own  sword  should  the  malady  of  Bohemond 
prove  fatal. 

Certain  other  female  physicians  of  this  period  are  men- 
tioned, notably  Abella,  who,  in  spite  of  the  modesty  that 
is  supposed  to  hedge  about  her  sex,  produced  in  Latin 
hexameter  a  work  entitled  De  Natura  Seminis  Hominis. 
Mercuriolus,  in  the  fifteenth  century,  produced  treatises  on 
the  cure  of  wounds,  pestilent  fevers,  and  on  the  nails. 
The  most  celebrated  of  all,  however,  appears  to  have  been 
Calenda,  who  lived  during  the  reign  of  that  notorious  prof- 
ligate, John  II,  of  Naples  (1414—1435),  and  who  was  par- 
ticularly distinguished  for  her  personal  attractions.  She 
graduated  with  great  honor  from  the  school  at  Salernum, 
and  soon  after,  in  1423,  married  a  nobleman  of  the  court, 
which  perhaps  accounts  for  the  fact  that  she  never  exercised 
the  privilege  of  authorship.  A  little  later.  Marguerite,  of 
Sicily  or  Naples,  also  a  Salernian  graduate,  acquired  an 
extended  professional  reputation,  and  was  licensed  to 
practice  by  Ladislaus,  King  of  Poland. 


INFLUENCE  OF  THE  SALERNIAN  SCHOOL.        81 

Daremberg  informs  us  that  there  were  numerous  fe- 
male physicians  at  Salernum,  much  sought  after  because 
of  their  talents,  and,  moreover,  highly  esteemed  by  the 
professors  of  the  school,  who  freely  quoted  the  writings 
of  their  fair  pupils  and  contemporaries;  further,  that  they 
employed  ointments  in  paralyses;  fumigations,  vapors,  and 
antimony  for  coughs ;  and  lotions  of  aloe  and  rose-water 
for  swellings  of  the  face;  they  combined  scientific  knowl- 
edge with  facetious  playfulness  in  a  manner  peculiar  to  the 
sex,  in  that  they  tendered  unsuspecting  beaux  bouquets  of 
roses  doctored  with  powdered  euphorbium,  and  hugely 
enjoyed  the  forced  sternutations  of  their  victims. 

It  will  thus,  be  seen  what  a  wide-spread  and  long-con- 
tinued influence  the  school  of  Salernum  exerted.  At  first 
physics  and  philosopliy  were  the  principal  branches  taught, 
but  later  the  other  sciences  were  cultivated.  The  Emperor 
Frederick  II  united  the  different  schools  of  the  city  into  a 
university, — a  term,  however,  that,  as  then  applied,  appears 
to  have  corresponded  to  what  in  the  nineteenth  century  is 
understood  by  corporation.  The  emperor  likewise  pub- 
lished several  decrees  which  revised  the  duties  and  privi- 
leges of  practitioners  of  medicine  and  surgery  in  his 
kingdom,  and,  in  1224,  ordered  that  no  person  should 
practice  witliin  the  two  Sicilies  until  examined  by  the 
faculty  of  the  university  and  licensed  at  the  royal  hands; 
further,  practitioners  were  compelled  to  devote  at  least 
one  year  to  the  study  of  anatomy.  The  faculty  at  this 
time  consisted  of  ten  professors,  whose  salary  probably 
depended  upon  the  number  of  pupils.  A  candidate  for 
graduation  was  required  to  present  proof  of  majority,  of 
legitimacy  of  birth,  and  of  proper  duration  of  preliminary 
study,  and  then  was  examined  publicly  in  the  Sy7iopsis  of 
Galen,  the  Aphorisms  of  Hippocrates,  or  the  Canon  of 
Avicenna.  On  passing  he  swore  to  conform  to  all  the 
regulations  hitlierto  observed  in  medicine,  to  give  gratu- 
itous treatment  to  the  poor,  and  to  expose  all  apotliecaries 


82  THE    HISTORY   OF   MEDICINE- 

detected  in  adulterating  drugs.  A  book  was  then  placed 
in  his  hands,  a  ring  upon  his  finger,  and  a  laurel  crown 
upon  his  head,  when  he  was  "  dismissed  with  a  kiss." 
The  degree  conferred  was  that  of  "-Magister" — the  modern 
title  of  Doctor  being  at  that  period  employed  almost  ex- 
clusively to  designate  a  public  teacher  or  professor. 

But  the  watchfulness  of  King  Frederick  was  not 
confined  alone  to  the  regulation  of  medical  study  within 
his  kingdom.  The  number  of  professional  visits,  and  the 
recompense  therefor,  were  fixed  by  law.  Every  physician 
was  compelled  to  visit  his  patients  twice  daily,  and  even 
once  at  night  as  well,  if  summoned,  and  for  this  attend- 
ance was  permitted  a  daily  fee  equivalent  to  fourteen  cents 
for  patients  within  the  city,  while  for  calls  without  the  city 
the  largest  legal  charge  was  one  dollar  and  tliirteen  cents, 
provided  he  paid  his  own  expenses 

The  earlier  teachings  and  practice  of  Salernum  were  a 
curious  mixture  of  methodism,  dogmatism,  and  super- 
stition. The  latter  may  be  better  understood  when  it  is 
recalled  that  the  practice  of  medicine  for  an  extended 
period  was  confined  almost  exclusively  to  ecclesiastics,  who 
by  their  very  education  were  prone  to  superstition  and 
upheld  the  efficacy  of  charms  and  relics,  and  the  active 
intervention  of  saints  and  martyrs  as  well  as  the  myrmi- 
dons of  evil ;  hence  arose  many  of  the  conflicts  and  absurd 
notions  peculiar  to  the  period.  The  prevalence  of  the 
doctrine  of  medical  methodism  was  due  to  the  character 
of  the  writings  most  accessible  to  students  of  that  day, — 
such  as  those  of  Coelius  Aurelianus  and  others ;  and  it  is 
curious  that  Celsus,  the  most  elegant  of  medical  authors, 
was  never  popular  among  medical  monks.  The  Hellenic 
language  having  almost  disappeared  from  Italy  by  the  sixth 
century,  the  works  of  the  Greek  authors  had  become  a 
sealed  book  to  a  vast  majority,  even  of  the  better  educated ; 
lience  tlie  purer  sources  of  medical  knowledge  were  not 
available.     Althouj^h  the  school  of  Salernum,  at  a  later 


THE    "FOUR   MASTERS."  83 

date,  prided  itself  upon  its  devotion  to  the  "  Father  of 
Medicine,"  the  Hippocratic  writings  were  not  known  at 
this  period;  and,  when  Constantino  the  African,  by  the 
translation  of  Arabian  works,  introduced  a  new  element 
into  the  Salernian  scliool,  he  ingrafted  upon  its  medical 
teaching  a  form  of  doctrine  which  found  a  congenial 
atmosphere,  in  which  it  throve  vigorously,  while,  a 
century  later,  the  translations  of  Gerard  of  Cremona  gave 
a  stronger  impulse  to  the  growth  of  Hippocratic  medicine 
than  to  Hippocratic  doctrine. 

From  the  Commentary  of  the  Four  Masters  we 
learn  that  Salernian  practitioners  recognized  the  diagnostic 
importance  of  nausea,  vomiting,  and  the  flow  of  blood 
from  the  ears  in  injuries  to  tlie  head;  that  they  resorted 
to  the  trepan  for  depressed  fractures  and  the  relief  of 
intracranial  extravasation  ;  that  hernia  cerebri  was  treated 
by  pressure  and  caustics  ;  that  ligatures,  both  above  and 
below  the  opening,  were  applied  for  the  treatment  of 
wounds  of  the  carotid  arteries  and  jugular  veins.  It  was 
advised  to  decline  patients  suffering  from  wounds  of  the 
heart,  lungs,  diaphragm,  stomach,  or  liver,  in  order  to 
avoid  the  disgrace  of  losing  them ;  and  in  penetrating 
Avounds  of  the  intestines  and  in  those  complicated  with 
protrusion  of  the  wounded  gut  instruction  was  given  how 
to  envelop  them  in  the  warm  abdomen  of  a  slaughtered 
animal  until  natural  color  and  temperature  were  restored, 
and  then  to  insert  a  cannula  of  alder-wood  into  the  wounded 
intestine,  which  was  to  be  neatly  closed  and  stitched;  finally, 
the  protrusion  was  to  be  carefully  washed  with  warm  water 
and  returned  into  the  abdominal  cavity,  enlarging  the 
o[)ening  for  this  purpose,  if  necessary.  Also  was  advised 
the  extraction  of  diseased  teeth ;  and  the  operation  of 
lithotomy  was  described  with  considerable  care.  Com- 
pound fractures  were  to  be  treated  with  splints.  On  the 
whole,  this  commentary  of  the  alleged  Four  Masters  is  the 
most  interesting  and  ancient  Salernian  work  which  has 


84:  THE   HISTORY    OF    MEDICINE. 

been  preserved,  and  is  well  worthy  the  attention  of  even 
modern  surgeons. 

Such  was  the  school  of  Salernum  in  its  prime,  during 
the  twelfth  and  thirteenth  centuries.  My  readers  will  not 
have  failed  to  note  liow  few  names  have  been  mentioned 
which  are  prominent  in  medical  history,  and  how  few 
improvements  were  made  in  medical  art  by  those  who 
have  been  mentioned.  One  naturally  inquires,  then,  wliat 
was  the  source  of  the  wide-spread  fame  of  Salerno  as  a 
school,  since  it  was  distinguished  neither  by  notable  dis- 
covery in  science  nor  by  celebrated  teachers,  and  the 
predominant  element  was  doubtless  one  of  obstinate  con- 
servatism and  unswerving  devotion  to  ancient  doctrines. 
Founded  during  the  dark  period  of  the  Middle  Ages,  at 
a  time  when  ignorance,  bigotry,  and  superstition  prevailed, 
it  preserved,  amidst  the  gloom  that  had  settled  upon 
Europe,  a  few  rays  of  that  intellectual  light  which  had 
shown  so  brightly  in  the  golden  ages  of  Roman  history. 
These  rays,  made  more  conspicuous  by  the  intellectual 
night  which  they  barely  illumined,  were  a  beacon  for  men 
who  were  groping  for  more  light.  Thus  the  name  of 
Salernum  became  synonymous  with  intellectual  advance- 
ment in  later  ages.  As  the  parent  and  model  of  our  mod- 
ern university  system,  Salernum  yet  deserves,  in  a  measure, 
to  enjoy  the  esteem  of  a  numerous  scholastic  offspring. 
At  a  time  when  priests  were  particularly  active  in  passing 
off  rudimentary  knowledge  for  the  science  of  healing  this 
school  began  to  secure  all  information  possible  from  the 
laity  for  the  progressive  development  of  medicine.  It 
began,  in  other  words,  to  hold  aloof  and  then  to  break 
away  from  the  fetters  of  a  fanatical  church.  Its  decline, 
too,  was  as  rapid  as  its  career  had  been  brilliant.  One 
very  serious  blow  was  struck  when,  in  1224,  Frederick  II 
founded  the  University  of  Naples  and  forbade  Neapolitan 
subjects  to  seek  instruction  at  any  other  university.  The 
next  year  a  revolt  in  the  city  provoked  the  closure  of  the 


PRIVILEGES   OF   THE   SALERNIAN    SCHOOL.  85 

schools  of  Bologna,  which  Avere,  however,  opened  again 
two  years  later.  AYithin  a  short  time  the  universities  of 
Naples,  Montpellier,  Padua,  Paris,  and  Bologna  all  entered 
into  a  contest  for  pre-eminence  with  a  rivalry  which  was 
not  always  generous.  In  1224,  it  is  said,  the  latter  uni- 
versity had  no  less  than  ten  thousand  students.  Happily, 
however,  the  period  of  the  Renaissance  proved  to  be  one 
of  emancipation  from  the  fetters  of  ignorance  and  super- 
stition, making  an  appeal  for  liberty  whicli  the  conservatism 
of  Salernum  could  not  brook,  Roger  Bacon,  in  England; 
Lanfranc  and  Guy  de  Chauliac,  in  France;  Mondino,  at 
Bologna,  and  Savonarola,  at  Padua,  found  no  rivals  at 
Salernum  to  successfully  contest  their  fame.  Thus  this 
ancient  school  fell  behind  the  age,  and  in  a  short  time 
sank  into  a  mediocrity  which  was  scarcely  brightened  by 
the  reflection  of  a  departed  glory.  In  1342  Robert  I  re- 
newed the  decree  of  Frederick  II,  which  closed  all  the 
schools  in  his  kingdom  save  those  of  Naples,  but  excepted 
Salernum  solely  because  of  its  antiquity  and  the  traditions 
of  his  predecessors.  In  1413  King  Ladislaus  excepted 
the  Salernian  alumni  and  professors  from' all  taxes,  duties, 
and  tribute.  In  the  middle  of  the  fourteenth  century  the 
poet  Petrarch  speaks  of  the  school  as  a  memory  of  the 
past;  but  its  last  appearance  was  in  1748,  when  a  dispute 
at  Paris  relating  to  the  rank  of  physicians  and  surgeons 
was  referred  to  Salerno's  university  for  arbitration  and  final 
decision.  In  1811  a  formal  decree  reduced  this  parent  of 
all  European  universities  to  a  mere  gymnasiunl  or  prepara- 
tory school ;  and  now  one  may  wander  through  the  streets 
of  the  modern  town  and  among  the  ruins  of  its  ancient  pre- 
decessor and  seek  in  vain  to  trace  some  reminder  of  those 
who  were  illustrious  during  some  of  the  most  terrible  ages 
in  the  world's  history.  No  echo  of  tradition,  no  stone  of 
ancient  edifice,  no  library  preserving  precious  manuscripts, 
not  even  an  edition  of  the  old  Salernian  regimen,  in  the 
whole  city ;  in  fact,  none  now  so  poor  as  to  do  it  reverence. 


CHAPTER  IV, 

Age  of  TEAXsrrioy  {concluded). — TJie  School  of  Montpellier:  Raimond  Lulli^ 
1235-1315.  John  of  Gjwldestlen,  1305-  (?).  Arnold  of  Villanova,  1234- 
1313.  Establishment  of  Various  Universities,  Gerard  of  Cremona,  f  1187. 
William  of  Salicet,  1280.  Lanfranc,  1315.  Mondino,  1275-1327.  Guy 
de  Chauliac,  1300-1370. 

Age  of  Rexovatiox,  1400  to  Present  Time. — Erudite  Period,  including 
Fifteenth  and  Sixteenth  Centuries.  Tliomas  Linacre,  1461-1524.  Sylvius, 
1478-1555.  Vesalius,  1514-1564.  Columbus,  1490-1559.  Eustachius, 
1500-1574.  Fallopius,  1523-1562.  Fabricius  ab  Aquapendente,  1537-1619. 
Fabricius  Hildanus,  1560-1634. 

Although  I  have  taken  up  so  much  time  with  an 
account  of  the  school  of  Salernum,  a  few  words  must  be 
devoted  to  the  school  of  Montpellier,  which  was  second  in 
time  and  in  importance  among  the  great  influences  in  the 
culture  of  western  Europe,  There  was  a  time  when  to 
have  studied  there  lent  a  special  halo  of  glory,  for,  being 
near  the  sea,  and  in  the  vicinity  of  thermal  baths,  even  so 
early  as  a.d.  1153  it  was  famous  as  a  school  of  medicine; 
moreover,  those  who  presided  over  it  did  not  lapse  uncon- 
ditionally into  mediaeval  philosophy,  with  its  bewildering 
subtleties.  It  is  said  to  have  been  founded  a.d.  738,  but 
first  mention  of  it  as  a  source  of  medical  education  occurs 
in  1137,  when  Bishop  Adelbert  II,  of  Mayence,  visited  the 
city  to  listen  to  its  medical  teachers.  A  faculty  of  philosophy 
was  added  in  1242,  and  one  of  law  in  1298,  Within  the 
walls  of  the  city  sojourned  both  Christians  and  Jews,  the 
latter  being  subject  directly  to  the  civil  authorities,  and 
particularly  esteemed  as  translators.  One  of  the  most 
famous  of  the  sons  of  Israel  was  Profatius  Judicus,  who 
became  a  rector  of  the  faculty. 

Prior  to  1370,  when  the  university  became  subject  to 
the  kings  of  France,  it  was  under  the  control  of  the  Pope ; 
and  then,  as  now,  the  school  of  medicine  was  the  chief 
ornament  of  this  ancient  seat  of  learning. 

One  of  the  most  illustrious  and  famous  pupils  of 
(86) 


THE   SCHOOL   OF   MONTPELLIER.  87 

Montpellier  was  that  religious  mystic  and  alchemistic 
visionary,  Raimond  Lull,  or  Lulli,  a  would-be  transmuter 
of  metals  and  seeker  for  the  philosopher's  stone.  Born 
in  1234,  at  the  age  of  thirty  he  began  to  see  visions, 
and  was  thereby  roused  from  an  atheistic  tendency  to 
soon  become  wonderfully  pious;  ultimately  he  entered  the 
order  of  Minorites,  studied  Arabic,  and  appeared  as  a  mis- 
sionary in  Africa,  seeking  to  convert  the  Saracens — who, 
however,  declined  the  honor,  and  finally  (in  1315)  rewarded 
his  zeal  by  stoning  him  to  death.  Beside  works  on  alchemy 
and  theology,  he  wrote  on  medical  subjects,  and,  like  all 
great  minds  of  the  period,  passed  among  the  common 
people  as  a  sorcerer  in  league  with  the  devil.  Neverthe- 
less, he  was  a  notable  figure  in  his  age  and  country. 

Quite  celebrated  became  the  compendium  of  Gilbert  of 
England  (1290),  which  contained  the  same  speculative 
nonsense,  the  same  polypharmacy,  and  the  same  superstition 
as  other  works  of  that  time;  what  little  it  contained  of 
value  was  taken  largely  from  other  writers.  While  this 
Gilbert,  often  known  as  Gilbertus  Anglicus,  was  not  the 
first  English  writer  on  practical  medicine,  he  was  the 
earliest  whose  works  have,  been  preserved. 

Still  more  famous  was  John  Gaddesden,  physician-in- 
ordinary  to  the  King  of  England,  professor  in  Merton 
College,  Oxford,  who  wrote  the  famous  treatise  known 
as  Rosa  Anglica^  which  appeared  between  1305  and 
1315.  This  treatise  was  characterized  by  mysticism  and 
disgusting  therapeutic  measures,  and  tainted  by  medical 
avarice,  superstition,  and  charlatanry.  Gaddesden  was, 
perhaps,  the  first  to  formally  recommend  the  "  laying  on 
of  hands"  by  the  king  for  the  cure  of  scrofula  (first 
performed  by  Edward  the  Confessor — 1042-1056),  wlience 
comes  the  ancient  name  for  this  disease, —  i.e.,  "king's 
evil."* 

*A  special  "Service  of  Healing"  was  used  In  the  English  Cbureli  under 
Heniy  VIII,  1484-1509. 


«8  THE   HISTORY   OF   MEDICINE. 

Arnold  de  Villeneuve  (1234-1313)  studied  seven  years 
at  Montpellier,  twenty  years  at  Paris,  visited  all  the  uni- 
versities in  Italy,  then  went  to  Spain  to  levy  on  tlie  Arabian 
authors.  He  wrote  on  medicine,* theology  and  especially 
on  chemistry — in  which  art  he  obtained  great  renown  both 
as  an  author  and  teacher.  To  him  is  due  the  discovery  of 
spirit  of  wine,  oil  of  turpentine,  aromatic  waters,  besides 
several  preparations  of  less  note,  and  the  introduction  of 
chemical  compounds  into  therapeutics.  His  was  a  very 
stirring  life,  for  he  traveled  extensively ;  he  became  a 
teaclier  at  Bologna,  and  physician  to  Peter  III,  of  Arragon. 
Shortly  before  his  demise  he  went  to  Paris,  having  fallen 
under  the  ban  because  of  a  declaration  tliat  papal  bulls,  far 
from  being  sacredly  inspired,  were  human  works,  and  that 
acts  of  charity  were  dearer  to  God  than  hecatombs,  etc. 
He  finally  perished  by  shipwreck,  but  the  spirit  of  fanat- 
icism followed  him  after  death,  for  his  volumes  were  con- 
demned by  the  Inquisition,  because  they  commended  ex- 
periments rather  than  mere  speculations.  In  spite  of  his 
general  honesty  in  accordance  with  the  spirit  of  the  times 
he  inculcated  deceit  in  medicine,  and  one  of  his  declarations 
is:  "If  thou  canst  not  find  anything  in  the  examination 
of  the  renal  secretion,  declare  that  an  obstruction  of  the 
liver  exists.  Particularly  use  the  word  'obstruction,'  since 
it  is  not  understood,  and  it  is  of  great  importance  that 
people  should  not  understand  what  thou  sayest,"  He  was 
one  of  the  first  to  administer  brandy,  which  he  regarded  as 
the  elixir  of  life — whence  the  modern  Eau  de  Vie. 

Connected  with  this  school,  also,  or  well  known  as 
having  studied  there,  were  many  men  whose  names  became 
more  or  less  famous — among  them  John  Arden,who  settled 
in  London  about  the  middle  of  the  fourteenth  century ; 
Vinario,  a  contemporary  of  Guy  de  Chauliac ,  and  the 
well-known  surgeon  and  anatomist  Henri  de  Mondeville, 
who  was  a  teacher  of  Guy  de  Chauliac.  But  an  idea  of 
the  doctrines  prevalent  in  the  medical  literature  of  tliis  part 


CATHEDRAL  MEDICAL  SCHOOLS.  89 

of  the  world,  at  this  time,  may  be  had  from  the  fact  that 
most  writers  chose  titles  for  their  works  after  the  style  of 
ballad  singers:  for  instance,  tliose  describing  the  plague 
and  venereal  diseases  were  called  Flowers  and  Lilies  of 
Medicine ;  the  Rosa  Anglica  of  John  Gaddesden  was 
another  example.  Matters  had  arrived  at  such  a  pass,  in- 
deed, tliat  men  of  science  no  longer  hesitated  to  confess 
superstition  and  mingle  it  openly  witli  deceit,  to  oppose  the 
interests  of  the  most  needy,  and  to  extort  from  their  fellow- 
creatures  fees  in  proportion  to  their  supposed  ability  to  pay. 
In  the  time  of  Charlemagne  each  cathedral  possessed  a 
school  in  which  were  taught  arithmetic,  theology,  singing, 
and  sometimes  medicine ;  the  Episcopal  College  had  medi- 
cal teachers  who  gave  advice  and  dressed  wounds  at  the 
doors  of  the  Cliurch  of  Notre  Dame,  Paris ;  but  when  the 
medical  profession  had  been  divorced  from  the  sacerdotal 
by  councils  and  popes,  many  of  these  cathedral  schools 
closed.  In  order  to  preserve  the  jurisdiction  which  they 
for  a  long  time  had  exercised  over  the  learned  professions, 
manv  were  erected  into  universities,  and  thus  the  clerjjv 
gave  instruction  in  philosophy,  theology,  and  later  in  medi- 
cine. During  the  thirteentli  century  arose  many  of  the 
great  universities  in  Europe,  notably  those  of  Bologna, 
Padua,  and  Naples,  in  Italy ;  of  Paris,  Montpellier,  and 
Toulouse,  in  France ;  of  Valencia  and  Tortosa,  in  Spain  ; 
of  Oxford,  in  England.  Pope  Innocent  III  by  papal  bull 
guaranteed  that  the  professors  and  students  at  Paris  should 
be  exempt  from  all  excommunications  save  those  which 
emanated  directly  from  the  Holy  See ;  French  sovereigns 
conferred  many  privileges  upon  the  universities,  and  soon 
the  members  of  the  University  of  Paris  formed  practically 
a  second  city,  with  its  own  laws,  customs,  police,  citizens, 
and  magistrates.  Still,  however,  all  science  belonged  to 
the  clergy,  and  its  teachers,  though  removed  from  the 
cloister,  were  none  the  less  Roman  Catholic;  so  that  the 
popes  reigned  over  the  people  through  the  parish  clergy, 


90  THE   HISTORY    OF   MEDICINE. 

and  over  the  latter  by  the  clerical  teachers  and  professors. 
Nevertheless,  in  all  candor  it  must  be  acknowledged  that 
these  studious  men,  thus  associated  together  for  mutual  in- 
struction and  emulation  in  learning,  contributed,  in  a  large 
measure,  to  elevate  Christian  civiUzation  above  all  others, 
though  several  generations  were  required  to  secure  the 
results  calculated  to  make  men  celebrated  ;  hence  the  early 
periods  of  the  universities  developed  very  few  names. 
Many  were  conspicuous  by  their  love  of  instruction,  but 
not  by  originality  of  research.  Men  undertook  expensive 
and  wearis.ome  voyages  without  encouragement  or  hope  of 
reward,  simply  to  obtain  some  rare  manuscript  or  to  hear 
some  renowned  professor;  and  they  appeal  to  us  of  the 
nineteenth  century  by  their  devotion,  if  not  by  the  results 
of  their  work. 

Among  the  somewhat  scattered  and  more  or  less 
eminent  men  of  this  period  was  Gerard,  of  Cremona  in 
Lombardy,  a  man  of  great  purity  and  studiousness,  who 
arduously  pursued  all  that  Latin  autliors  could  teach  him, 
and,  not  being  able  to  procure  in  Italy  certain  manuscripts 
which  dated  from  the  time  of  Ptolemy,  determined  to  go  to 
Toledo  in  search  of  an  Arabian  translation.  At  this  time 
he  was  unacquainted  with  Arabic,  but  soon  mastered  it, 
and — armed  with  this  powerful  resource,  which  no  other 
physician  had  possessed  since  the  time  of  Con stan tine  the 
African — he  could  not  see  so  n:;any  Arabic  works  devoted 
to  all  branches  of  science  as  wcx'e  gathered  at  the  Spanish 
University  without  a  desire  to  translate  and  transmit  the 
same  to  his  own  country  ;  hence  he  gave  the  remainder 
of  his  life  to  this  work.  He  rendered  into  Latin  the 
treatises  of  Hippocrates  and  Galen,  of  Serapion,  and  of 
all  the  famous  Arabian  authors  from  the  time  of  Rhazes, 
including  the  Canon  of  Avicenna  and  the  work  on  sur- 
gery by  Albucassis.  He  died  at  the  age  of  seventy-three, 
in  1187,  at  Cremona,  and  left  all  his  books  to  tlie  monas- 
tery of  St.  Lucy,  within  whose  walls  he  was  buried. 


WILLIAM    OF    SALICET.       LANFRANC.  91 

William  of  Salicet,  born  at  Piacenza  in  the  first  years 
of  the  thirteenth  century,  became  a  professor  in  the  Uni- 
versity of  Bologna,  and  later  at  Verona.  He  wrote  ex- 
tensively on  medicine,  and  earned  a  reputation  as  a  surgeon 
that  preserves  his  fame  to  the  present  day.  It  is  claimed 
that  his  status  in  medical  literature  depends,  in  large  meas- 
ure, upon  the  fact  that  he  was,  perhaps,  the  first  to  refuse 
slavish  obedience  to  preceding  authors,  preferring,  instead, 
to  draw  upon  the  results  of  personal  study  and  experience. 
He  died  in  1280. 

Lanfranc,  or  Lanfranchi  (according  to  whether  one  pre- 
fers his  French  or  Italian  name),  studied  under  William  of 
Salicet.  Of  his  early  life  very  little  is  known,  save  that  he 
practiced  surgery  in  Milan  at  the  time  of  the  great  dissen- 
sion between  the  Guelphs  and  Ghibellines,  and,  for  attach- 
ing himself  to  the  weaker  party,  was  exiled  and  forced  to 
seek  an  asylum  in  France ;  he  resided  in  Lyons  for  se\^ral 
years,  and  here  wrote  a  work  on  minor  surgery;  in  1295 
he  went  to  Paris  on  the  invitation  of  the  faculty  of  medi- 
cine, opened  a  course  on  surgery  which  met  with  great  suc- 
cess, and  then  published  a  second  and  larger  treatise  on  the 
subject.  It  is  said  of  him  by  Malgaigne  that,  less  from  his 
fault  perhaps  than  that  of  his  age,  after  his  death  (about 
lf315)  surgery  began  to  decline.  From  the  time  of  Brunus, 
who  practiced  in  Padua  in  1250,  the  barbers  had  done  the 
scarifying  and  bleeding.  After  the  time  of  Lanfranchi  there 
were  others  who  applied  leeches  and  often  cauteries,  and 
even  the  women  meddled  with  surgery  and  in  all  operations 
competed  with  the  barbers;  the  lay  surgeons  held  them- 
selves rivals  to  the  clergy.  Lanfranchi  inherited  from  his 
old  master,  William,  an  aversion  for  them  all,  and  often 
had  to  contend  with  uneducated  and  incompetent  laymen. 
Clerical  surgeons  regarded  operations  as  beneath  their 
dignity;  and  Lanfranchi,  who  deplored  this  condition  of 
affairs,  confessed  he  had  sometimes  bled  with  his  own  hands, 
but  had  never  operated  for  ascites,  hernia,  cataract,  or  stone. 


92  THE   HISTORY    OP    MEDICINE. 

John  Pitard  has  descended  to  fame  not  as  a  writer,  but 
as  tlie  founder  of  the  surgical  schools  of  St.  Come  and  St. 
Damien,  which  occupy  so  eminent  a  position  in  the  sur- 
gical annals  of  France.  In  1306  he  was  surgeon  to  the 
King  of  France,  Philip  le  Bel,  and  the  sworn  surgeon  of 
Cliatelet.  The  Collet^e  of  St.  Come,  in  1311,  was  only  a 
little  brotherhood  of  lay-surgeons,  who  gradually  grew  in 
importance  as  the  result  of  the  obstinate  struggles  sus- 
tained,— on  the  one  hand,  against  the  faculty  of  medicine, 
and,  on  the  other,  against  the  barber-surgeons.  Malgaigne 
has,  with  great  patience  and  clearness,  shown  that  tlie  im- 
portance of  this  body  of  men  has  been  greatly  exaggerated 
by  historians ;  he  has  traced-  their  various  turns  of  fortune 
from  beginning  to  end ;  I  shall  have  occasion  to  consider 
them  again  farther  on. 

Mondino,  sometimes  known  as  Mundinus,  born  in 
1275,  became  a  professor  in  the  University  of  Bologna, 
and  died  in  1327,  He  was  the  author  of  a  celebrated 
treatise  on  anatomy,  said  to  have  reached  twenty-five 
editions,  and  which  was  the  first  of  its  kind  since  Galen. 
This  science  had  been  greatly  neglected ;  in  Salernum, 
for  instance,  they  were,  for  a  long  time,  contented  with 
the  treatise  of  Copho  on  the  anatomy  of  the  hog,  and 
most  of  the  anatomical  knowledge  of  the  age  was 
apparently  derived  from  this  source ;  Mondino  resur- 
rected the  study  and  pursued  it  with  interest  and  enthu- 
siasm, though  under  the  greatest  difficulties.  His  works 
for  more  than  two  centuries,  along  with  the  writings  of 
Galen  and  the  Arabic  authors,  served  for  anatomical 
demonstration,  although  very  incomplete, — as  witness  the 
statement : — 

"  Beneath  the  veins  of  the  forearm  we  see  many 
muscles  and  many  large  and  strong  cords,  of  which  it  is 
not  necessary  to  attempt  the  anatomy  on  such  a  corpse 
{i.e.,  a  recent  one),  but  on  one  dried  in  the  sun  for  three 
years,   as    I    have    shown    otherwise,    in    developing   the 


GUY    DE    CHAULIAC.  93 

number  and  the  anatomy  of  those  of  the  superior  and 
inferior  extremity." 

On  the  other  hand,  he  took  the  opposite  course  to  dis- 
cover and  demonstrate  tlie  nerves,  and  advised  maceration 
in  running  water.  It  required  almost  superhuman  bold- 
ness to  substitute  demonstrations  on  the  human  cadaver 
for  those  u[)ou  swine,  yet  this  was  done  by  Mondino  ;  and 
at  the  time  tlie  prejudice  against  dissection  was  so  general 
that  for  more  than  a  century  after  Mondhio — who  died  in 
1327 — no  one  dared,  at  least  publicly,  to  emulate  his  ex- 
ample. It  was  in  the  year  1315  that  he  publicly  dis- 
sected the  bodies  of  two  women  in  Bologna.  Anatomical 
study  was  further  complicated  at  this  time  by  certain 
bulls  of  Pope  Boniface  VIII,  forbidding  evisceration  or 
boiling  or  cooking  any  part  of  the  human  body;  these 
deliverances  were  really  aimed,  not  against  scientific 
investigation,  but  at  the  absurd  custom  introduced  by 
the  crusaders  of  cutting  up  and  boiling  the  bodies  of 
their  relatives  who  died  in  infidel  countries,  in  order  to 
send  them  home  for  burial  in  holy  ground ;  never- 
theless, the  papal  injunction  certainly  operated  to  dis- 
courage and  prohibit  anatomical  dissection,  since  nearly 
two  hundred  years  later  the  University  of  Tiibingen  was 
obliged  to  apply  to  Pope  Sixtus  IV  for  permission  to 
authorize  dissection. 

Guy  de  Chauliac,  born  in  Gevandan  about  1300,  was 
the  most  famous  physician  and  surgeon  in  Christendom 
during  the  Arabic  period.  He  studied  at  the  cathedral 
college  of  Mende,  whicli  at  that  time  was  quite  celebrated, 
and  was  taught  medicine  at  Montpellier  under  the  best 
masters  of  his  day.  It  is  probable,  also,  that  he  studied 
in  Paris,  and  certain  that  later,  in  Bologna,  he  saw  dis- 
sections made.  Dissatisfaction  with  the  writings  of  the 
ancients  and  the  knowledge  which  he  obtained  at  the 
schools  stimulated  his  own  powers  of  observation,  and  he 
became,  in  every  respect,  an  original  student  and  acquired 


94  THE    HISTORY   OF   MEDICINE. 

a  degree  of  erudition  far  more  extended  than  that  pos- 
sessed by  any  of  his  contemporaries.  He  practiced  in 
various  places,  longest  at  Lyons  ;  and  finally  entered  the 
service  of  Pope  Clement  VI,  at  Avignon,  and  probably 
enjoyed  the  same  honor  under  Innocent  V  and  Urban  V; 
when  the  latter  was  made  pope,  in  1362,  de  Chauliac 
became  his  chaplain,  or  chapel-reader.  In  1363  he  pub- 
lished a  work  on  surgery  called  The  Inventory^  upon 
which  his  fame  chiefly  rests,  though  several  other  volumes 
emanated  from  his  pen.  None  knew  better  than  he  how 
to  unite  respect  for  the  ancients  with  justice  toward  con- 
temporaries, and  he  cited  a  large  number  of  Greek, 
Arabian,  and  Latin  authors,  some  of  M'hom  are  now 
utterly  unluiown.  The  sciences,  he  declared,  are  "  created 
by  successive  additions ;  the  same  man  cannot  lay  the 
foundation  and  perfect  the  superstructure.  We  are  as 
children  carried  on  the  neck  of  a  giant ;  aided  by  the 
labors  of  our  predecessors  we  see  all  that  they  have  seen, 
and  something  beside."  In  tracing  the  character  of  a 
surgeon  he  recommends  that  he  be  "  learned,  expert,  in- 
genious, bold  where  he  is  sure,  timid  when  in  doubt, 
avoiding  bad  cures  and  practices,  being  gracious  to  the 
sick,  generous  and  compassionate,  wise  in  prediction, 
chaste,  sober,  pitiful,  and  merciful ;  not  covetous  nor  ex- 
tortionate, but  receiving  moderate  fees  according  to  the 
circumstances  of  his  patients,  the  character  of  the  case, 
and  his  own  dignity,"  "  Never  since  Hippocrates,"  says 
Malgaigne,  "  has  medicine  learned  a  language  stamped 
with  such  nobility  and  in  such  few  words."  Although  a 
follower  of  Galen,  in  anatomy  he  insisted  on  the  necessity 
of  dissection,  and  proposed  to  make  use  of  the  corpses  of 
executed  criminals  for  this  purpose.  The  drawings  made 
by  Henri  de  Mondeville  were  known  to  him  ;  he  divided 
abscesses  into  hot  and  cold,  although  among  the  latter  he 
included  cedema,  tympanites,  dropsy,  scirrhus,  and  other 
conditions.     In    practice   he    was    more    timid,  yet    more 


RELIGIOUS   ORDERS   AND   THE    SICK.  95 

active,  than  Lanfranchi,  who  never  cut  for  stone,  but  left 
that  operation  to  the  traveling  surgeons.  De  Chauliac 
described  it  as  he  liad  seen  it  performed ;  he  opened  the 
abdomen  for  dropsy,  did  not  hesitate  to  attempt  the  radical 
cure  of  hernia,  and  operated  for  cataract.  The  plague 
which  raged  during  the  fourteenth  century  and  depopu- 
lated the  known  world  of  one-fourth  of  its  inhabitants, 
twice  appeared  in  Avignon  while  Guy  de  Chauliac  was  a 
resident  there — and  he  acknowledges  that  nothing  but 
shame  prevented  him  from  fleeing.  He  remained  at  his 
post,  visited  the  sick,  and  was  himself  attacked  and  left 
for  dead.  "  In  this  frightful  position  he  had  suflicient 
presence  of  mind  to  follow  the  peculiarities  of  his  case, 
analyze  his  own  suflerings,  and  to  give  a  description  of 
tliem  worthy  of  Hippocrates "  (Renouard).  His  work 
soon  became  the  surgical  code  of  Christendom,  and  was 
commented  upon  and  translated  into  all  tongues,  remain- 
ing for  a  long  time  a  classic,  and  even  at  this  day  it  pre- 
serves much  of  its  interest  as  representing  the  condition  of 
medical  science  at  the  close  of  the  Middle  Ages ;  more- 
over, its  literary  style  was  much  superior  to  that  of  any  of 
his  contemporaries,  all  of  whom  wrote  very  barbarous 
Latin.     He  died  about  1370. 

With  the  death  of  de  Chauliac  terminates  our  interest, 
not  merely  in  the  Arabian  physicians  and  those  who  were 
intimately  connected  with  them,  but  in  the  so-called  Arabic 
Period.  It  may  be  added,  in  passing,  that  the  followers  of 
Mahomet,  like  those  of  Christ,  erected  by  the  side  of  each 
of  their  mosques  a  school,  and  often  a  hospital,  endowed 
with  more  or  less  generosity  by  caliphs  or  the  wealthy,  who 
hoped  to  purchase  redemption  and  eternal  happiness  by 
such  liberality. 

A  certain  number  of  religious  orders  or  communities 
were  established  during  the  Middle  Ages  to  give  succor  to 
the  deserving  sick,  the  most  widely  known  being  those  of 
St.   Mary;  St.  Lazarus;  St.  John,  of  Jerusalem;  and  the 


96  TUK    HISTORY    OF    MEDICINE 

Daughters  of  God.  To  be  sure,  some,  through  the  endow- 
ment of  the  opulent,  became  rich  beyond  all  reason,  and 
departed  from  their  primitive  purposes,  and  thus  not  only 
excited  the  covetousness  of  monarchs,  but  had  even  the 
temerity  to  resist  their  authority.  This  compelled,  every 
now  and  again,  a  suppression  of  some  order  or  institution — 
partly,  perhaps,  for  laxity  of  morals,  and  partly  because  of 
their  turbulence.  Of  this  period  it  may  be  said  that  char- 
itable zeal  for  the  sick  was  never  more  pronounced ;  princes, 
bishops,  and  popes  gave  examples  of  devotion  by  dressing 
with  their  own  hands  the  ulcers  of  lepers — and  leprosy 
was  in  those  days  a  frightful  disease,  having  been  con- 
tracted by  the  crusaders  in  the  Orient,  and  everywhere 
spread  as  they  returned,  being,  moreover,  favored  by  the 
miserable  uncleanliness  which  was  tlien  so  common. 
Ignorance,  dread,  and  fear  rendered  this  disease  worse  than 
usual,  and  it  was  confounded  with  other  maladies  less 
formidable.  It  has  been  estimated  that  in  the  fifteenth 
century  Europe  liarbored  no  less  tlian  nineteen  thousand 
lepers ;  and  that  the  disease  was  a  great  terror  is  mani- 
fest by  the  excessive  caution  taken  against  its  spread: 
its  victims  were  forbidden  to  enter  cities,  and  on  the 
highway  were  compelled  to  stand  aside  lest  they  should 
taint  passers-by  witli  their  breath;  even  a  healthy  person 
convicted  of  being  touched  by  a  leper  was  banished  from 
society;  any  infraction  of  these  rules  was  punishable  by 
death.  It  will  thus  be  seen  wliat  deptli  of  genuine 
humanity  it  required  to  have  anything  to  do  with  one 
of  these  outcasts. 

Another  institution  prevailed  widely  during  these 
days, — namely,  public  baths,  wliich  were  established  in 
nearly  every  city  and  increased  to  such  an  extent  that 
in  the  fifteenth  century  the  bathers  of  Paris  constituted 
a  powerful  brotherhood,  so  powerful,  in  fact,  that  Jacque 
Despars,  physician  to  Cliaries  VII,  and  one  of  the  most 
renowned  professors  of  the  faculty,  for  speaking   openly 


REVIEW^    OF   THE    ARABIC    PERIOD.  97 

against  the  abuse  of  public  baths,  was  obhged  to  leave 
the  capital  to  avoid  persecution. 

A  study  of  the  general  history  of  the  Arabic  Period 
reveals  that  the  Arabs,  previously  obscure  and  uncivilized, 
emerged  rapidly  from  the  demi-savage  state,  and  took  the 
first  rank  among  the  polished  nations  of  the  world.  During 
the  earliest  portion  of  this  period  these  people  were  religious 
vandals  and  destructive  fanatics,  but  later  embraced  with 
enthusiasm  and  persistence  a  study  of  the  humanities,  and 
endeavored  to  repair  their  early  ravages  by  collecting  the 
dSbris  of  the  literary  and  scientific  monuments  of  Greece; 
but,  though  they  cultivated  medicine  with  zeal  and  success, 
they  added  little  to  the  Greek  treasures.  Later,  Arabia 
was  overrun  by  hordes  from  the  deserts  of  Tartary,  a  people 
yet  more  barbarous  and  unknown,  who  established  them- 
selves in  all  parts  of  the  globe  then  under  Saracenic 
dominion,  and  by  their  brutal  despotism  degraded  the 
Arabians  to  a  condition  approaching  that  from  which 
they  had  emerged.  This  seems  to  have  been  ever  the 
result  of  Turkish  conquest. 

Meanwhile  the  Greek  nation,  which  was  for  so  many 
ages  at  the  head  of  civilization,  gradually  lost  its  power, 
virtue,  courage,  glory,  and  independence,  and  continued 
to  descend,  until  now  it  exercises  no  influence  whatever 
on  the  course  of  events.  During  the  course  of  the  Arabic 
Period  only  one  Grecian  physician  merits  mention  on 
account  of  his  writings,  and  in  these  there  was  nothing 
new  except  what  he  had  borrowed  without  credit  from 
the  Saracens. 

The  Empire  of  the  West, — that  is,  the  western  part 
of  the  ancient  Roman  Empire, — after  subjugation  by  bar- 
barians from  Germany  and  Scandinavia,  fell  under  a  cloud 
whose  darkness  overwhelmed  it.  Its  people,  however, 
gradually  received  new  life  by  commingling  their  blood 
with  that  of  the  invaders.     Later  they  were  able  to  repulse 


98  THE    HISTORY    OF    MEDICINE. 

the  Saracens  who  poured  in  upon  them  from  Spain;  then 
they  turned  their  armies  against  each  other,  and  wrought 
mutual  havoc  and  ruin  for  several  centuries.  Again,  roused 
by  rehgious  fanaticism,  as  had  been  the  Mohammedans 
previously,  they  rushed  by  thousands  upon  the  plains  of 
Asia  Minor,  Syria,  and  Egypt,  which  had  been  for  cent- 
uries occupied  by  the  Arabs;  and  tlieir  adventures  and 
enterprises,  and  the  new  and  varied  scenes  tlirough  wliich 
they  passed,  gave  rise  among  the  "Francs"  to  some  taste 
for  poetry  and  works  of  imagination  During  the  twelfth 
and  thirteenth  centuries  governments  became  more  stable, 
liberal  institutions  were  created,  the  rust  of  ignorance 
gradually  disappeared,  and  by  the  end  of  the  Arabic 
Period  there  were  really  apparent  brilliant  streaks  of 
mentality  in  the  horizon  of  the  nations  of  Europe.  In 
tliis  progressive  movement  the  study  of  medicine  shared. 
In  the  thirteenth  century  it  was  wortliily  represented  in 
Italy,  in  Paris,  and  became  established  in  Montpellier. 
Notwithstanding,  up  to  this  time  physicians  apparently 
only  knew  how  to  timidly  follow  in  the  track  of  the 
Arabians,  and  approached  little,  or  not  at  all,  in  their 
studies,  the  purer  lore  of  the  Greeks. 

THE   AGE   OF    RENOVATION. 

This  Age  of  Renovation  (extending  from  the  com- 
mencement of  the  fifteenth  century  to  the  present  time, 
according  to  Renouard's  classification)  is  divided  into  the 
Erudite  Period,  comprising  the  fifteenth  and  sixteenth 
centuries,  and  the  Reform  Period,  comprising  the  seven- 
teenth and  eighteenth  centuries,  and  one  should  add,  in 
fact,  the  nineteenth.  In  general  literature  this  age  is 
known  as  that  of  the  Renaissance,  and  is  one  of  whose 
beginning  a  great  deal  has  been  written,  and  so  much 
better  than  I  can  put  it  in  this  brief  work,  that  to 
general  sources  I  should  perhaps  refer  those  who  are  in- 
terested in  knowing  how  and  why  there  came  about  such 


THE   AGE   OF    RENOVATION.  99 

a  tremendous  change  in  methods  and  habits  of  thought  and 
in  acquirement  of  knowledge.  But  it  is  the  history  of 
medicine  that  at  this  time  we  particularly  desire,  and  our 
minds  must  be,  in  some  slight  degree,  prepared  for  tlie  great 
changes  to  be  recounted  by  some,  with  the  conditions  which 
brought  about  this  revolution.  It  was  truly  an  awakening 
in  every  department  of  knowledge  and  along  every  line  of 
study ;  it  was  as  if  the  minds  of  men  had  been  dormant  and 
lost  their  power  of  receptivity,  and,  after  a  long  period  of 
torpor,  awakened  in  a  new  atmosphere  amid  new  surround- 
ings ;  as  if  there  had  burst  upon  them  a  sudden  appre- 
ciation of  ability  to  do  things  hitherto  undreamed  of,  and 
to  acquire  knowledge  such  as  hitherto  had  been  possessed 
by  none.  Once  free  from  the  shackles  imposed  by  authority 
of  the  past,  these  minds  severed  their  Gothic  bonds,  and 
started  forth  in  every  direction  with  the  ardor  of  youth  and 
the  interest  of  novelty,  all  engaging  in  the  general  enter- 
prise of  erecting  from  the  debris  of  antique  science  a  new 
temple  to  the  mind  in  which  to  worship.  While  some 
delved  among  the  records  of  the  past,  others  sought  to  bind 
the  past  and  present,  and  others,  bolder  yet,  cut  entirely 
loose  from  it,  rejected  all  tradition,  and  would  fain  have 
built  this  temple  with  entirely  new  materials. 

Now,  what  led  to  this  sudden  awakening  %  Was  it 
chance,  or  the  effect  of  certain  causes  which  had  long  been 
operating'?  It  has  been  seen  that  hospitals  and  various 
institutions,  whose  foundations  were  dedicated  to  humanity, 
were  erected  in  all  parts  of  Europe ;  that  gradually  there 
had  come  about  a  better  social  organization ;  that  there 
had  been  a  diminution  of  conflicts  between  princes  and  their 
vassals,  and  the  relations  between  the  two  were  more  nearly 
at  an  equilibrium.  Moreover,  the  invention  of  the  compass, 
which  rendered  long  voyages  less  dangerous  and  more  fre- 
quent, opened  up  to  trade  regions  hitherto  inaccessible  or 
unknown,  and  attracted  interest  toward  commerce  as  a 
means  of  pecuniary  gain.     The  telescope  liad  been  invented, 


100  THE   HISTORY   OF    MEDICINE. 

and  astronomy  was  able  to  seize  upon  some  of  the  facts  by 
it  revealed,  and  thereby  to  make  more  interesting  calcula- 
tions concerning  the  motions  of  celestial  bodies,  and  attain 
a  knowledge  of  our  solar  system  and  its  laws.  Gradually 
the  microscope  shed  light  upon  the  hitherto  unseen  ;  en- 
graving on  copper  had  added  its  power  of  illustration  to 
the  works  of  the  great  writers  as  they  appeared;  but  above 
all,  that  wliich  brought  about  this  condition  of  affairs  was 
the  discovery  of  the  art  of  printing.  The  jfirst  attempts 
in  this  direction  were  made  between  the  years  1435 
and  1440,  and  by  the  united  efforts  of  three  men,  whose 
names  deserve  mention  so  long  as  their  art  exists, — 
namely,  Guttenberg,  Faust,  and  Sclioeffer.  Thanks  to  them 
the  same  information  could  be  multiplied  in  manifold  form 
and  transmitted  to  all  parts  of  the  civilized  globe.  In  this 
way  intelligence  and  reason  become  triumphant ;  thence- 
forward the  dominion  of  brute  force  was  broken,  and 
knowledge,  because  capable  of  dissemination,  became  im- 
perishable. 

At  the  commencement  of  the  Erudite  Period  Arabic 
literature  still  predominated  in  medicine.  Rhazes,  Haly- 
Abbas,  and  Avicenna  were  universally  invoked  and  ex- 
plained. But  a  taste  for  Greek  literature  began  to  prevail 
in  the  universities  of  Italy,  and  was  finally  extended  to 
every  part  of  Europe,  especially  after  the  taking  of  Con- 
stantinople by  Mahomet  II,  Emperor  of  the  Turks,  in 
1453.  This  disaster,  wliich  at  first  bade  fair  to  be  a  mortal 
blow  to  Greek  literature  and  language,  strange  to  say, 
served  only  to  hasten  their  resurrection  in  the  Occident. 
Constantinople  having  been  given  over  to  pillage  at  this 
time,  most  of  its  learned  men  escaped,  carrying  with  them 
all  manuscripts  that  could  be  seized ;  most  of  these  found 
refuge  in  Italy,  and  enlightened  protectors  in  the  all- 
powerful  prince  of  the  house  of  Medici,  in  Florence,  in  the 
popes  at  Rome,  and  in  Alphonso,  of  Arragon,  King  of 
Naples  and  Sicily.     Everywhere  these  fugitives  spread  the 


LEONICENUS.       LIN  ACRE.  101 

knowledge  of  the  masterpieces  of  Greek  literature  and  art, 
and  in  this  way  a  taste  for  books,  libraries,  and  sound 
erudition  was  diffused,  while  the  Greek  and  Latin  classics 
were  hunted  up  and  published  with  great  patience  and 
ardor;  thus  the  works  of  the  old  writers  were  edited, 
translated,  commented  upon,  and  everywhere  disseminated 
throughout  Europe. 

Among  those  who  devoted  themselves  to  the  thankless 
task  of  editing,  and  purifying  from  interpolations,  the 
works  of  the  classic  writers  was  Nicholas  Leonicenus, 
born  near  Vincenza  in  the  year  1428,  who  studied  medi- 
cine at  Padua  and  taught  it  for  more  than  sixty  years  at 
Ferrara.  He  possessed  great  vigor  of  mind,  with  purity 
of  manners  and  serenity  of  soul,  and  was  the  first  to  trans- 
late directly  from  Greek  into  Latin  the  aphorisms  of  Hip- 
pocrates and  portions  of  the  writings  of  Galen.  He  com- 
bated in  every  way  the  infatuation  of  his  contemporaries 
for  the  Arabians  and  their  lore,  and  called  attention  to 
many  of  the  errors  of  men  who,  like  Pliny  the  naturalist, 
had  fallen  for  lack  of  fully  understanding  the  Greek  au- 
thors they  compiled.  At  the  ripe  age  of  ninety-six  he  died, 
regretted  by  all. 

Thomas  Linacre,  of  Canterbury,  a  contemporary  of 
Leonicenus,  though  younger  (1461-1524),  studied  first  at 
the  University  of  Oxford,  went  to  Italy  in  1484,  and  in 
Florence  attracted  the  attention  of  Lorenzo  de  Medici,  who 
made  him  the  companion  of  his  own  children,  to  whom  he 
gave  the  best  possible  advantages.  In  due  time  he  returned 
to  England,  where  his  talents  speedily  won  him  high  sta- 
tion, and  he  became  physician  to  King  Henry  VIII,  and 
later  to  Queen  Mary.  Linacre  was  the  first  Englishman, 
it  is  said,  who  spoke  purely  the  language  of  the  Romans. 
He  translated  several  books  of  Galen  that  are  still 
esteemed ;  and  caused  the  founding  of  two  chairs,  one  at 
Oxford,  the  other  at  Cambridge,  whose  incumbents  were 
charged  with  the  duty  of  explaining  the  works  of  Hippoc- 


102  THE    HISTORY    OF   MEDICINE. 

rates  and  Galen.  But  he  is  most  entitled  to  the  gratitude 
of  his  countrymen  for  his  influence  in  founding  the  College 
of  London.  To  appreciate  properly  its  importance  and  his 
merits,  we  must  remember  the  obstacles  that  had  to  be  sur- 
mounted ;  for  at  that  time  bishops  alone  had  the  right  to 
accord,  in  their  own  dioceses,  permission  to  practice  medi- 
cine, and,  consequently,  the  healing  art  was  abandoned 
entirely  to  monks  and  illiterate  empirics.  It  was  well  that 
Linacre  had  influence  at  court,  else  he  could  never  have 
obtained  the  reform  of  such  overwhelming  abuses ;  but  he 
triumphed  in  spite  of  powerful  opposition,  and  secured  tlie 
issue  of  letters  patent  which  prohibited  the  practice  of 
medicine  by  any  one  who  had  not  received  a  degree  in  one 
of  the  two  universities  in  the  kingdom,  and  been  examined 
by  the  President  of  the  College  of  London  assisted  by  three 
others.  This  was  the  achievement  which  gave  this  learned 
man  the  title  of  "Restorer  of  Medicine"  in  England. 

Leonicenus  and  Linacre,  who  were  of  the  early  Eru- 
dite Period,  also  merit  mention  not  merely  because  of 
literary  talents,  but  because  they  were  tlie  first  eminent 
physicians  to  embrace  the  study  of  Greek  classics,  and  to 
propagate  the  knowledge  therein  contained.  Subsequently 
others  followed  the  same  course, — too  many,  in  fact,  to  be 
enumerated ;  but  it  was  easy  to  follow  after  such  leaders. 
From  the  time  when  men  began  to  realize  the  superiority 
of  Greek  models  over  prolix  Arabian  commentaries,  they 
were  anxious  to  seek  the  light  at  its  source,  and  applied 
themselves  with  avidity  to  the  study  of  tlie  originals.  At 
this  time  copies  of  Greek  authors  were  few  in  number  and 
in  a  deplorable  condition,  owing  to  neglect.  To  rediscover 
them,  to  purify,  to  eliminate  what  was  not  original,  to  re- 
arrange, and  finally  to  multiply  by  the  aid  of  the  printing- 
press  was  an  extended  labor  requiring  great  knowledge, 
rare  sagacity,  and  commendable  patience.  One  of  the 
greatest  publications  in  medical  literature  belonging  to  thif 
epoch  was  a  com})lete  edition  of  the  Hippocratic  writings. 


DIFFICULTIES   ATTENDING   DISSECTION.  103 

translated  into  Latin  by  Anuce  Foes, — a  poor,  but  learned, 
practitioner,  who  lived  on  the  products  of  liis  business  as 
pension  physician  in  the  city  of  Metz, — and  issued  from 
Frankfort-on-the-Main  in  1495.  To  this  master-work 
Foes  consecrated  forty  years  of  his  life.  Another  treatise 
belonging  to  this  same  time,  less  important,  perhaps,  from  a 
medical  point  of  view,  but  nevertheless  showing  great 
erudition,  was  a  treatise  on  the  gymnastics  of  the  ancients, 
by  Jerome  Mercurialise  a  work  said  to  be  not  less  precious 
to  historians  than  antiquarians.  It  was  by  such  intense 
zeal  and  hard  labor  that  true  erudition  was  restored  in 
Europe. 

Following  now  some  of  the  special  branches  of  medical 
learning  and  their  development,  let  us  look  first  at  anatomy 
and  physiology.  I  have  already  related  the  salient  points 
of  the  life  and  labors  of  Mondino,  of  whom  it  is  said  that, 
about  the  year  1315,  while  professor  at  Bologna,  he  dis- 
sected the  bodies  of  two  women,  and  shortly  after  pub- 
lished an  epitome  of  anatomy  illustrated  with  wood-cuts. 
Also  has  been  mentioned  the  prohibition  of  anatomical 
study  pronounced  by  Pope  Boniface  VIII,  in  1300.  It 
was  only  toward  the  close  of  the  fifteenth  and  the  early 
years  of  the  sixteenth  century  that  this  prejudice  began  to 
abate ;  the  popes,  who  then  stood  at  the  head  of  scientific 
movements,  withdrew  their  interdictions,  and  the  universi- 
ties of  Italy  gave  public  dissections.  Achillini,  Benedetti, 
and  Jacques  Berenger  dissected  at  Bologna,  Padua,  and 
Pavia,  previous  to  the  year  1500;  soon  afterward  their 
example  was  generally  followed. 

Jacques  Dubois,  whose  name  was  Latinized  into  Jaco- 
bus Sylvius,  was  born  in  1478,  in  a  village  near  Amiens; 
he  studied  in  Paris,  where  he  worked  most  industriously 
at  anatomy,  which  later  he  was  so  successful  in  teaching. 
He  was  the  first  to  arrange  all  the  muscles  of  the  human 
body,  to  determine  their  functions,  and  to  give  names  to 
those  of  them  which  had  not  yet  been  so  designated.     He 


104  THE   HISTORY   OF   MEDICINE. 

discovered  the  valves  of  the  large  veins,  and  was  the  first 
to  study  the  blood-vessels  by  means  of  colored  injections. 
He  gave  the  same  careful  attention  to  pharmacy,  and  in 
Paris,  before  a  large  class  of  students,  began  lectures  on 
anatomy,  physiology,  hygiene,  pathology,  and  therapeutics; 
these  he  continued  until  the  faculty,  on  account  of  jealousy, 
interrupted  them.  He  then,  in  1529,  went  to  Montpellier, 
but  returned  two  years  later  to  become  a  member  of  the 
faculty,  and  once  more  lectured  with  the  greatest  eclat. 
Later  yet  he  became  a  successor  to  Vidius  in  the  Royal 
College, — a  position  he  retained  up  to  his  death  in  1555. 
His  medical  writings  were  extensive  and  marked  by  great 
accuracy,  while  for  anatomy  he  did  a  great  deal,  contrib- 
uting much  to  popularize  it.  He  dissected  a  great  number 
of  animals  and  as  many  human  cadavers  as  he  could  pro- 
cure, the  number,  however,  being  small.  Unfortunately, 
he  subordinated  all  his  own  research  to  the  autliority  of 
Galen,  being  himself  among  those  anatomists  who  per- 
mitted themselves  to  be  so  far  misled. 

The  man  of  genius  and  courage,  who  accepted  the 
truth  of  what  his  eyes  revealed  to  him,  and  who  was  the 
true  reformer  in  anatomy,  was  Andreas  Vesalius,  born  at 
Brussels,  in  1514,  of  a  family  already  illustrious  in  medi- 
cine. He  studied  at  tlie  University  of  Louvain,  where  he 
early  revealed  the  inclinations  of  the  anatomist,  since  in 
his  leisure  moments  he  was  wont  to  amuse  himself  in 
dissecting  small  animals.  Near  Louvain  was  a  place 
where  criminals  were  executed ;  and  Vesalius,  having 
observed  the  body  of  one  from  which  the  soft  parts  had  all 
been  cleaned  away  by  ravenous  birds,  only  the  bones  and 
ligaments  remaining,  detached  the  extremities  separately, 
and  then  carried  oif  the  trunk  by  night,  thus  possessing 
himself  of  his  first  skeleton.  Attracted  by  the  fame  of 
Sylvius,  he  afterward  went  to  Paris  to  become  his  pupil, 
but,  not  content  with  the  lessons  of  his  master,  continued 
to  observe  for  himself     On  the  hill  Montfaucon,  n^iere 


VESALIUS. 


105 


executions  took  place,  he  disputed  with  dogs  and  vultures 
for  the  remahis  of  criminals,  or  by  stealth  disinterred 
bodies  from  the  cemeteries  at  the  greatest  personal  risk. 
So  great  was  his  application  that  his  progress  became 
rapid,  and  at  the  age  of  twenty  he  gave  instruction  to 
fellow-students ;  at  twenty-two  he  became  Professor  of 
Anatomy  at  Padua,  being  appointed  by  the  Senate  of 
Venice ;  at  twenty-nine  he  issued  his  great  work  on  anat- 


Fia.  7.— Andreas  Vesalius. 

(From  an  old  etching  by  Esine  de  Bonlonois.) 


omy,  which  showed  a  completeness  that  left  far  in  the  rear 
all  that  had  hitherto  been  published  on  this  subject.  The 
following  year  he  was  called  by  the  Emperor  Charles  V  to 
the  court  of  Madrid,  then  the  most  brilliant  in  Europe, 
wliere  he  became  the  first  physician,  and  from  this  time 
abandoned  his  anatomical  labors. 

lie  was  the  first  who  dared  to  dispute  the  words  of 
Galen  and   point  out  his   errors, — to   ascertain   that  the 


TITT 


ANDRK.AX     VESALI 

BRV.Xr.  LLCS  SIS,     I  N  \- 

ftifsiiiii  C  A  RO L I  V.  ImpiT.ito: 

iTiCi!i».i,dc  Huirwtii  corporis 

Jj'iricj  Ubn  kptcni. 


jie  .  if  tit 


-J 


Fig.  8.— TiTiE-PAGE  OF  "The  Seven    11u..ks  ui     uik  anatomy  of  thk 
Human  Body,"  by  Andreas  Vesalius,  ok  Ukussels,  Physician  to 

THE  iNVINCIBIiE  EMPEROB  CHARLES  V. 

(Published  iu  two  folio  vulunies  in  Ba««l  in  1555.) 


COLUMBUS.      EUSTACHIUS.  107 

greater  part  of  Galen's  descriptions,  having  been  made 
from  monkeys,  did  not  correctly  represent  human  anatomy. 
This  audacity  raised  a  crowd  of  vehement  opponents,  the 
least  reasonable  and  most  fanatic  being  his  old  master, 
Sylvius ;  but  even  these  onslaughts  could  not  conceal  the 
truth.  The  minds  of  men  generally  were  ripe  for  the 
revolution  whose  signal-fire  was  thus  lighted,  and  no 
sooner  did  Vesalius  appeal  from  the  decision  of  Galen  to 
observation  of  nature  than  a  crowd  of  anatomists  were 
ready  to  follow  his  method.     He  died  in  1564. 

One  who,  at  Padua,  had  been  first  his  pupil,  then  his 
co-laborer, — namely,  Columbus,  born  at  Cremona  in  1490, 
— succeeded  him.  Columbus  criticised,  in  some  respects, 
the  statements  of  his  eminent  predecessor,  which  he  could 
better  do,  since  he  is  said  to  have  dissected  fourteen  bodies 
every  year,  as  well  as  to  have  practiced  venesection.  He 
came  so  near  to  discovering  the  mystery  of  the  circulation 
that  it  is  strange  how  he  could  have  missed  it.  He  even 
appreciated  the  systole  and  diastole  of  the  heart  and  the 
connection  thereof  with  dilatation  and  contraction  of  the 
arteries.  He  knew,  also,  that  the  pulmonary  veins  con- 
ducted arterial  blood,  and  that  the  pericardium  was  a  shut 
sac.  He  even  appreciated  the  lesser  circulation,  since  he 
described  how  the  blood  left  the  right  side  of  the  heart 
and  passed  into  the  lungs,  and  came  back  through  the 
veins  into  the  left  ventricle ;  because  of  this  discovery,  and 
in  spite  of  his  utter  failure  to  appreciate  the  greater  circu- 
lation, he  has  been  by  some  regarded  as  entitled  to  the 
credit  which  is  universally  given  to  Harvey.  From  his 
position  as  teaclier  in  Padua  Columbus  was  called  to  Pisa, 
and  from  Pisa  to  Rome,  where  he  died  in  1559. 

Another  of  the  great  anatomists  of  tliis  period,  second 
only  in  fame  to  Vesalius,  was  Eustachius,  born  about  the 
beginning  of  the  sixteenth  century.  He  became  physician 
to  the  Duke  of  Urbino,  and  in  Rome  a  city  physician  and 
professor  of  anatomy,  continuing  to  teach  in  the  latter  city 


IV 


V 


ai 


.^A 


F1Q.9.—IV,  Forceps  FOB  Extracting  Balls.  V.  A  Denticulated  Form 

OF  Forceps. 

(From  Opera  Omnia  Anatomica  el  Chiruigiea,  bv  Andreas  Vesaliiit.  1568.) 


FALLOPIUS.      FABRICIUS. 


109 


until  overtaken  by  liis  final  sickness.  He  was  a  defender 
of  Galen  rather  than  an  opponent,  and  sought  to  shelter 
his  reputation  from  the  attacks  of  Vesalius.  In  his  praise 
it  must  be  said  that,  for  his  day,  he  was  a  great  anatomist; 
his  chief  discoveries  were  in  the  domain  of  comparative 
anatomy.  He  brought  to  bear  upon  his  work  a  knowl- 
edge of  embryology  which  enabled  him,  for  instance,  to 
describe  the  kidneys  and  the  teeth  much  more  accurately 
than  would  otherwise  liave 
been  possible;  he  noted, 
also  the  pathological 
changes  in  bodies  dissected, 
and  is  brought  daily  to  our 
minds  as  we  think  of  the 
connecting  channel  be- 
tween the  pharynx  and 
the  middle  ear,  to  which 
his  name  has  been  given. 
He  died  in  1574. 

Fallopius,  born  in 
Modena,  in  1523,  was  pro- 
fessor successively  at  Fer- 
rara,  Pisa,  and  Padua.  He 
cultivated  anatomy  with 
the  greatest  ardor,  and,  in 
consequence,  his  name  is 
also  linked  with  that  of 
Vesalius,  as  are  those  of 
Herophilus  and  Erasistratus  in  the  history  of  ancient  anat- 
omy. His  anatomical  researches  included  all  parts  of  the 
human  body,  and  his  name  has  been  given  to  the  tube 
through  which  the  ovum  enters  the  cavity  of  the  uterus. 
Death  overtook  him  in  the  year  1562. 

Jerome  Fabricius,  better  known  as  Fabricius  ah  Aqua- 
pendente^  was  born  in  the  town  of  the  latter  name,  near 
the  southern  end  of  the  Apennines,  in  1537,  received  his 


Pig.  10— Ga-brtbi,  FAtiiOPius. 

(From  an  old  etching  of  the  sixteenth  century.) 


110  THE    HISTORY    OF    MEDICINE. 

early  education  in  Padua,  and  studied  anatomy  under  Fal- 
lopius,  whose  assistant  lie  also  was.  After  the  death  of 
the  latter  he  succeeded  to  the  professorship  of  anatomy, 
and  later  built,  at  liis  own  expense,  a  large  anatomical 
theater,  in  which  he  lectured  and  demonstrated  to  students 
from  all  parts  of  the  world.  Toward  the  end  of  his  life 
he  had  accumulated  a  large  number  of  specimens,  and 
published  extensively  on  anatomy,  embryology,  physiology, 
and  surgery.  Though  often  accredited  with  discovering 
the  valves  of  the  veins,  he  is  not  entitled  to  that  honor, 
since  Erasistratus,  Sylvius,  Vesalius,  and  others  had  pre- 
viously described  them,  Estiennes  had  seen  them  in  the 
azygos  veins,  and  Canano  in  other  veins.  His  true  claim 
to  glory  rests  upon  embryological  researches,  which  he 
was  the  first  to  undertake  in  a  com})arative  way.  In  De 
Formato  Fcetii  he  elucidated  the  development  of  the 
embryo  and  its  membranes  by  a  long  list  ol'  observations 
on  lower  animals  of  many  species.  He  was  probably  the 
first  to  describe  the  uterine  decidua.  Fabricius  died  in 
1619. 

This  Fabricius  must  not  be  confused  with  the  almost- 
as-renowned  Fabricius  Hildanus,  who  was  born  in  Hilden, 
near  Dusseldorf,  in  1560.  Under  the  German  name  of 
Wilhelm  Fabry  he  became  widely  known  as  a  surgeon, 
and,  after  traveling  through  France,  settled  in  Hilden,  but 
later  moved  to  Cologne,  where  he  founded  an  academy. 
His  first  treatise — on  gangrene  and  sphacelus — quickly 
made  him  known,  and  went  througli  eleven  editions. 
From  Cologne  lie  went  successively  to  Genf,  Lausanne,  and 
Polen;  returned  to  Cologne;  and  finally,  after  several  other 
visits,  settled  in  Bern,  where  he  died  of  gout  and  asthma 
(in  1634).  His  frequent  changes  of  location  were,  perhaps, 
less  the  result  of  instability  than  a  testimony  to  his  repu- 
tation, inasmuch  as  he  was  invited  from  one  place  to 
another.  He  has  been,  with  propriety,  named  the  "  German 
Pare,"  since  he    rendered  such  great  service   to  German 


FABRICIUS   HILDANUS. 


Ill 


surgery,  and  was  not  only  an  expert  therein,  but  likewise 
a  cultivated  pliysician  and  polished  humanitarian ;  in  fact 
he  was  ahead  of  his 
time,  by  many  years, 
in  these  regards,  as  is 
shown  by  his  recom- 
mending amputation 
in  cases  of  gangrene, 
and  his  writings 
concerning  gunshot 
wounds.  He  enjoyed 
a  ripe  experience  also 
in  obstetrics,  and  even 
instructed  his  wife  in 
the  obstetric  art  and 
praised  her  ability 
most  highly.  His 
most  important  con- 
tributions to  literature 
were  in  the  field  of 
surgery,  and  these 
passed  through  nu- 
merous editions,  while 
his  opinions  and  prac- 
tice are  quoted  even 
to-day. 

During  this  epoch 
many  modifications 
were  introduced  and 
improvements  made 
in  the  teaching  of 
medicine.  Permanent 
am  pi  li  theaters       were 

established  for  dissection,  and  chairs  of  anatomy  created, 
their  incumbents  being  paid  out  of  the  public  treasury. 
The  popes   appear  to  have    taken    the   initiative   in  this 


Fig.  11.— Forms  of  Forceps  for  Enlargino 
Wounds. 

(From  Oprra  Omnia  Anatnmica  et  Chirurgiea,  by 

Andreas  Vesalins,  1568.) 


112  THE    HISTORY    OF    MEDICINE. 

respect,  whicli  accounts  for  the  great  number  of  sub- 
jects with  which  Eustachius  was  supphed,  as  compared 
with  VesaHus,  who  obtained  only  two  or  three  in  a 
year.  Up  to  this  time  the  razor  had  been  the  sole  in- 
strument of  dissection^  but  was  now  replaced  by  the 
scalpel,  which  remains  in  use  to-day.  By  the  labors 
of  the  few  men  mentioned  anatomy  acquired  a  degree 
of  perfection  which  it  had  never  attained  under  the 
Greeks.  Skillful  artists  put  their  labors  upon  paper,  and 
plates  and  descriptions  made  from  anatomical  preparations 
represented  the  various  parts  of  the  human  body  witli  more 
fidelity  than  had  been  supposed  possible.  Nerves,  ten- 
dons, and  ligaments  were  no  longer  confused,  but  traced  so 
far  as  possible  from  origin  to  ramifications.  Ancient  errors 
generally  were  corrected.  It  was  proven  that  there  was 
no  bony  structure  in  the  tissue  of  the  heart,  that  the  par- 
tition between  its  cavities  was  not  porous ;  and  attentive 
examination  of  its  valves  led  to  the  discovery  of  the  lesser 
circulation  by  Columbus.  Michael  Servetus,  whom  John 
Calvin  burned  at  the  stake,  was  perhaps  the  first  to  note 
this  phenomenon.  He  saw  that  the  blood  could  not  pene- 
trate directly  from  the  right  into  the  left  cavity  of  the 
heart,  but  that  it  was  necessary  for  the  whole  fluid  to  pass 
through  the  lungs,  where  it  became  impregnated  with  the 
vital  spirit  of  the  atmosphere,  and  reached  afterward  the 
left  auricle  ;  the  position  of  the  valves  in  the  pulmonary 
arteries  and  veins  clearly  confirmed  his  conjecture.  More- 
over the  size  of  the  pulmonary  arteries  was  enormous,  and 
disproportionate  to  the  quantity  of  blood  necessary  for  the 
nutrition  of  the  lungs,  which  seemed  to  prove  that  this 
was  not,  as  had  been  believed,  the  sole  purpose  of  those 
vessels.  It  was  about  this  time  that  Fabricius  ab  Aqua- 
pendente  pointed  out  valves  in  veins  in  various  parts  of 
the  body,  and  that  Columbus  and  Andreas  Cesalpinus  ex- 
plained more  fully  the  mechanism  of  the  lesser  circulation  ; 
in  fact,  the  former  so  closely  approached  an  appreciation 


FAILURE   TO   DISCOVER   THE   CIRCULATION.  113 

of  the  purpose  of  the  vascular  system  that  some  have 
thought  he  really  knew  it,  but  the  passages  in  his  writings 
thought  to  sustain  this  opinion  are  not  at  all  conclusive. 
He  seems  to  have  confused  the  action  of  the  heart  during 
sleep  with  that  during  the  waking  hours ;  and  although 
he  realized  that  the  blood  could  not  flow  backward  through 
the  arteries,  that  the  vena  cava  was  the  only  vessel  which 
permitted  the  entrance  of  blood  into  the  heart,  and  though 
he  spoke  of  anastomosis  between  arteries  and  veins  and 
remarked  that  if  a  band  be  applied  around  a  limb  the 
veins  swell  below  the  ligature,  he  contented  himself  with 
comparing  the  motion  of  the  blood  with  the  flux  and 
reflux  of  Euripus,  as  Aristotle  had  done.  It  is  even  thus 
tliat  he  tortured  his  mind  in  trying  to  reconcile  two  irrecon- 
cilable theories, — i.e.,  the  opinion  of  the  ancients  on  the 
motion  of  the  blood  and  recent  discoveries  in  the  anatomy 
of  the  vascular  system. 


CHAPTER  V. 

Age  of  Rexovatiox  {continued). — Erudite  Period  (continued):  Benivieni, 
1 1502.  Jean  Fernel,  1497-1558.  Porta,  1536-1615.  Severino,  1580-1656. 
Incorporation  of  Brotherhood  of  St.  Come  into  the  University  of  Paris,  1515. 
Ambroise  Pare,  1510-1590.  Guillemeau,  1550-1613.  Influence  of  the  Occult 
Sciences:  Agrippa,  1486-1535.  Jerome  Cardan,  11501.  Paracelsus,  1493- 
1541.     Botal,  bom  1530.     Joabert,  1529-1583. 

In  the  domain  of  pathology  the  Arabs  had  added  only 
a  very  small  number  of  observations  to  those  contained  in 
the  works  of  Galen.  The  most  interesting  of  these  per- 
tain to  eruptive  fevers.  Most  of  their  writers  contented 
themselves  with  making  an  inventory  of  the  acquisitions 
of  the  past,  as  did  Guy  de  Chauliac,  and  this  was  about 
all  they  could  do  under  existing  circumstances;  although 
tliey  did  not  make  discoveries,  they  prepared  the  way  for 
their  successors. 

Two  men  about  this  time  did  a  great  deal  in  the  direc- 
tion of  creating  a  desire  for  post-mortem  study  of  cases, 
and  in  illustrating  and  succinctly  describing  symptoms. 

The  first  of  these  was  Benivieni,  a  Florentine,  who 
died  in  1502 — the  date  of  his  birth  being  uncertain.  To 
him,  more  than  to  any  other,  we  owe  the  commencement 
of  the  study  of  gross  pathology  and  pathological  anatomy. 
He  was  tlie  first  to  consider  the  knowledge  that  might  be 
obtained  by  opening  bodies  for  the  sole  purpose  of  ascer- 
taining the  location  and  cause  of  the  diseases  from  which 
they  had  died.  As  Malgaigne  remarks :  "  A  eulogy  which 
he  merits,  and  which  he  shared  with  no  other  person,  and 
which  has  not  been  accorded  to  him  up  to  this  time  by  the 
many  historians  of  surgery  who  have  superficially  searched 
among  these  precious  sources,  is  that  he  was  the  first  who 
had  the  habit,  felt  the  need,  and  set  the  useful  example, 
which  he  transmitted  to  his  successors,  of  searching  in  the 
cadaver,  according  to  the  title  of  liis  book,  for  the  concealed 
causes  of  disease."  The  work  referred  to  bv  Malgaigne 
(114) 


BENIVIENI    AND    THE   BEGINNINGS   OF    PATHOLOGY.       115 

was  entitled:  Concerning  Some  of  the  Secret  and  Strange 
Causes  of  Disease  and  was  published  in  Florence  in  1507. 
It  is  poor  in  quotations,  but  rich  in  original  observations, 
which  pertain  especially  to  the  etiology  of  disease,  and 
gives  a  very  concise  symptomatology  and  history  of  each 
affection  of  which  it  treats,  as  well  as  a  pathological 
explanation.  Benivieni's  observations  on  gall-stone,  on  the 
anatomical  lesions  of  heart  diseases,  and  on  the  conveyance 
of  syphilis  from  the  mother  to  the  foetus  were  original,  as 
well  as  many  observations  concerning  the  presence  of  worms 
and  otlier  parasites  in  the  body. 

He  did  not  limit  himself  to  dissection  of  his  own  cases, 
but  sought  autopsies  in  the  cases  of  others.  He  examined 
the  bodies  of  those  who  had  been  hung,  always  thinking 
to  find  in  them  something  of  interest.  In  this  regard  he  was 
followed  by  one  already  mentioned, — namely,  Eustachius. 

After  these  two  the  men  who  most  cultivated  pathology 
and  anatomy  in  the  sixteenth  century  were  Rembert 
Dodoens  and  Marcellus  Donatus.  The  former  was  born  in 
1517,  in  Mecheln,  traveled  extensively,  was  physician  to 
Maximilian  II  and  the  Emperor  Rudolph,  and  died  in 
1585,  The  latter  lived  and  worked  in  the  latter  half 
of  the  sixteenth  century,  the  dates  of  his  birth  and  death 
being  somewhat  uncertain. 

The  next  man  whom  we  must  mention  is  one  who 
did  a  great  deal  for  internal  medicine,  pathology,  and 
anatomy,  Jean  Fernel,  who  has  been  surnamed  ^'  the 
modern  Galen,"  was  born  in  Clermont  in  1497.  Even 
as  a  boy  he  showed  great  aptitude,  and  very  early  made 
himself  a  reputation  in  philosophy,  law,  and  mathematics. 
In  1580  he  was  received  as  doctor,  with  the  unanimous 
applause  of  the  entire  faculty  of  Paris.  He  seems  to 
have  been  stimulated  by  this  only  to  more  extended 
study;  in  fact,  so  hard  did  he  work  at  his  studies  that 
his  friends  became  seriously  alarmed  for  his  health,  and 
remonstrated  with  him;  they  received  for  reply:  '''■Destiny 


116  THE   HISTORY    OF   MEDICINE. 

reserves  for  us  repose  enough''  He  became  physician  to 
King  Henry  H,  of  France,  and  in  the  midst  of  a  very 
extensive  practice  undertook  to  collect  all  the  medical 
knowledge  scattered  in  the  Greek,  Arabic,  and  Latin 
works,  in  order  to  form  from  it  a  body  of  doctrines. 
His  work  was  written  with  a  purity  and  elegance  of 
Latin  that  reminds  one  of  Cicero.  Throughout  its  pages 
he  was  philosophic,  and  sought  to  unite  the  apparently 
irreconcilable  doctrines  of  Plato  and  Aristotle. 

He  divided  medical  science  into  three  great  sections, — 
physiology,  pathology,  and  therapeutics.  In  his  explana- 
tions of  disease  he  was  too  often  fanciful,  following  the 
speculations  mainly  of  Galen,  and  making  free  use  of 
the  hypotheses  of  humors,  temperaments,  vital  spirits,  etc. ; 
but  the  following  statement  of  his  would  do  credit  to  a 
trained  pathologist  of  to-day:  "As  for  myself,  I  shall  never 
believe  1  have  profound  knowledge  of  any  affection  if  I  do 
not  know  positively,  just  as  if  I  could  see  it  with  my  eyes, 
in  what  part  of  the  human  body  is  the  disease,  its  primitive 
seat,  what  suspicion  of  organic  lesions  constitute  it,  whence 
it  proceeded,  if  it  exists  idiopatliically  or  by  sympathy,  or 
if  it  be  kept  up  by  some  exterior  cause.  He  who  pretends 
to  be  a  rational  physician  must  sound  each  of  these  subjects, 
and  discern  them  by  certain  signs."  The  problem  which 
he  thus  set  himself  he  certainly,  for  his  own  part,  considered 
as  solved,  although  it  was  not  long  before  his  solutions 
were  set  aside  and  the  original  uncertainty  reappeared. 

In  therapeutics  he  very  early  laid  down  the  fundamental 
maxim  that  every  disease  must  be  combated  by  contrary 
remedies,  justifying  this  by  every  species  of  argument, 
amounting  to  this :  that  every  disease  must  be  combated 
by  its  contrary  because  all  that  cures  a  disease  is  contrary 
to  it.  This  was,  in  part,  the  doctrine  of  '■'■  Contraria  con- 
trariis  curantur'' — the  antithesis  of  the  equally  absurd 
sophism :  "  SlmUia  simiUbns  curanhir"  which  three  hun- 
dred years  later  was  erected  into  an  excuse  for  the  founda- 


.4^ 


Fig.  12.— Body  Showing  Various  Kinds  of  Wounds. 

(From  Oprrii  Omnin  Anntmnica  r,t  Chirurgica,  by  Andreas  Vesaliue,  156''  ■* 


118  THE    HISTORY    OF    MEDICINE. 

tioii  of  an  alleged  new  school.  Tliere  can  be  no  doubt 
that  Fernel  rendered  very  great  service  to  his  time  and  to 
subsequent  generations,  despite  the  fact  that  his  recom- 
mendations and  statements  were  too  often  founded  upon 
sophistry. 

Just  here  we  must  digress  for  a  moment  to  consider  the 
status  of  bleeding.  Hippocrates  and  Galen  had  advised  to 
bleed  largely  from  the  arm  on  the  affected  side  in  pleurisy 
and  pneumonia.  That  practice  was  gradually  abandoned 
as  Greek  traditions  were  lost  sight  of,  and  finally  the  Arabs 
substituted  for  it  something  entirely  different, — namely, 
pricking  a  vein  in  the  foot  in  order  to  let  blood  flow  drop 
by  drop.  Their  method  prevailed  throughout  Europe  until 
the  commencement  of  the  sixteenth  century,  or  about  the 
time  when  Fernel  appeared  upon  the  scene.  A  Parisian 
physician  named  Brissot  had  revived  the  ancient  (the 
Greek)  practice  during  an  epidemic  of  pleurisy,  and  had 
obtained  thereby  astonishing  success,  which  he  hastened  to 
publish,  commending  the  method  employed.  He  thus 
created  a  great  uproar  in  the  medical  world.  The  innova- 
tion found  foes  and  defenders,  and  disputes  grew  warm, 
even  to  the  fever  point.  Finally,  the  ancient  method  was 
generally  revived,  and  Fernel  accepted  it. 

Felix  Plater  was  born  in  1536,  in  Basel,  Switzerland, 
and  died  in  1614.  He  had  several  sons  who  made  their 
mark  in  medicine.  In  his  large  work,  which  preceded  that 
of  Fernel,  he  took  perhaps  the  first  step  in  an  unexplored 
route, — namely,  in  the  classification  of  disease  according  to 
the  totality  of  apparent  symptoms.  Defective  as  this  classi- 
fication appears  in  our  eyes,  its  author  lived  a  long  life  as 
a  very  distinguished  practitioner  and  professor  in  his  native 
town. 

Giovanni  Batista  Porta  was  born  in  Naples  in  1536, 
traveled  extensively  in  Italy,  France,  and  Spain,  and 
founded  in  1560  an  Academy  of  the  Segreti.  He  was 
accused  of  rnagic,  and  was  compelled  to  refute  the  charges 


BARBER-SURGERY    IN    THE    XVI  AND    XVII   CENTURIES.        119 

in  Rome.  He  died  in  1615,  having  been  one  of  the  lead- 
ing scientists  of  his  time,  and  the  founder  of  modern  optics. 
In  the  first  edition  of  his  Magla  Naturalis,  published 
in  Naples,  1587,  is  found  the  first  description  of  the  camera 
obscura, — of  course,  in  a  very  incomplete  form  and  without 
lenses. 

Severino  was  a  celebrated  surgeon  of  Naples.  He  was. 
born  in  1580,  in  Calabria,  studied  in  Naples,  became  a 
doctor  in  Salernum,  and  then  became  professor  of  anatomy 
in  his  native  town.  For  a  long  time  the  victim  of  intrigue 
and  of  persecution  by  the  Inquisition,  he  was  finally  driven 
out  of  Naples,  but  was  called  back  by  the  populace.  He 
then  became  the  most  celebrated  teacher  of  his  time,  writing 
extensively  on  a  variety  of  subjects.  He  died  in  1656  of 
the  plague,  an  epidemic  of  which  was  at  that  time  raging 
in  central  Italy. 

Arriving  now  at  the  surgery  of  this  Age,  we  find  that 
matters  were  more  chaotic  than  in  other  departments  of 
medicine,  and  for  reasons  which  are  easily  given  and  appre- 
ciated. While,  ordinarily,  external  diseases  are  more  easily 
discerned  than  internal,  and  while  in  a  corresponding  de- 
gree they  can  be  more  satisfactorily  treated ;  while,  in  other 
words,  external  pathology  has  ordinarily  taken  precedence 
of  internal  in  professional  as  in  lay  minds,  this  view  seems 
to  have  been  inverted  for  a  time  during  the  Middle  Ages. 
Previous  to  the  period  now  under  discussion  the  sciences 
had  generally  declined  in  Europe,  and  surgery  had  fallen 
even  lower  than  medicine,  for  the  reason  that  medicine  was 
in  the  hands  of  the  priests,  who  had  at  that  time  something 
of  a  liberal  education,  while  the  practice  of  surgery  was 
abandoned  to  a  class  of  ignorant  barbers,  bathers,  and 
bone-setters.  No  mechanic  or  artisan  could  take  as  an 
apprentice  any  youth  without  a  certificate  affirming  his 
legitimate  birth,  and  that  he  came  from  a  family  in  which 
there  were  neither  barbers,  bath-keepers,  shepherds,  nor 
butchers.     Among   the  men   who   were  thus  made  social 


120  THE   HISTORY    OF    MEDICINE. 

outcasts  were  those  into  whose  hands  most  of  the  surgery 
of  the  fifteenth  century  fell.  This  was  particularly  the 
case  in  Germany,  and  other  European  countries  were  little 
in  advance.  We  have  seen  that  in  France  and  in  Italy 
Lanfranc  and  Guy  de  Chauliac  did  their  best  to  rescue  sur- 
gery from  the  hands  of  these  men,  but  their  efforts  did  not 
prevent  it  from  being  completely  abandoned  by  the  clergy, 
who  devoted  themselves  to  the  practice  of  medicine. 

When  we  come  to  inquire  the  reason  for  this — in  other 
words,  why  an  art  so  useful  as  surgery,  and  one  whicli 
made  such  requirements  for  knowledge,  sagacity,  and  dex- 
terity, whose  necessity  was  almost  continually  felt,  particu- 
larly during  these  troublous  times  of  almost  constant 
warfare,  should  be  so  neglected  by  men  who  could  best 
comprehend  its  utility  and  respond  to  its  requirements — it 
is  difficult  to  find  a  satisfactory  answer.  The  social  con- 
dition of  the  times  sheds  some  light  upon  the  question. 
The  nations  of  southern  Europe  were  socially  divided  at 
that  time  into  the  nobility,  who  were  nearly  always  at  war ; 
the  clergy,  who  monopolized  learning  and  filled  the  so- 
called  liberal  professions ;  and,  finally,  the  common  people, 
who  were  common  prey  for  both  the  other  classes,  and  who 
yet  had  to  support  both  without  having  any  privileges  of 
their  own.  While  the  practice  of  medicine  was  a  clerical 
right,  the  canon  of  the  church  prohibited  physicians  from 
drawing  blood,  under  pain  of  excommunication  ;  and  hence 
surgery,  shunned  by  the  priests,  to  whom  it  naturally  be- 
longed in  connection  with  the  practice  of  medicine,  fell  into 
the  hands  of  the  ignorant  and  vulgar,  who  practiced  it  in  a 
purely  mechanical  way,  without  knowledge  or  appreciation 
of  its  possibilities.  In  addition  to  this,  there  was  an  almost 
total  lack  of  detailed  and  precise  anatomical  knowledge,  and 
but  small  reason  to  expect  that  the  ignorant  practitioners 
of  surgery  would  feel  the  need  of  such  knowledge.  More- 
over, most  of  the  operators  were  itinerants,  going  from  city 
to  city,  stopping  so  long  as  they  had  cases  to  operate  upon 


FlO.    l;{.— MODK  OK    KXTKACTINO    LiCAUKN    liUM.ETS. 
(Fprni  O/w-irr  Omuiii  Aniiiumint  rl  Vhirnrgini.  \>y  Andreaa  Vetaliui,  1M8.) 


122  THE    HISTORY    Or    MEDICINE. 

or  until  some  reverse  forced  them  to  depart.  Most  of  these 
men  Hmited  themselves  to  one  or  two  sorts  of  operations. 
Some  operated  for  cataract,  others  for  stone,  others  for 
hernia,  nearly  every  one  having  a  secret  method  which  was 
transmitted  to  his  posterity  as  a  heritage. 

In  the  liistory  of  medicine  certain  family  names  of 
itinerant  operators  have  been  preserved ;  for  example,  the 
Branca,  the  Norsini,  in  Italy,  and  the  Colot  in  France. 

Under  such  conditions  there  could  be  no  such  thing  as 
the  profession  of  the  surgeon.  The  prejudice  against  dis- 
section did  not  begin  to  abate  until  the  thirteenth  century, 
when  a  very  few  of  the  clergy  dared,  in  a  very  timid  manner, 
to  perform  surgical  operations.  Their  numbers  increased 
in  the  course  of  the  fourteenth  and  fifteenth  centuries,  and 
in  the  sixteenth  had  become  considerable.  Most  of  the 
great  anatomists  of  that  period — such  as  Benivieni,  de 
Carpi,  Vesalius,  Fallopius,  and  Fabricius  ab  Aquapendente 
— were  great  surgeons. 

In  due  time  it  came  about  that  while  the  clerical  phy- 
sicians were  willing  to  descend  to  the  rank  of  operators, 
the  lay-surgeons  aspired  to  the  rank  of  doctors  of  medicine. 
This  transformation  took  place  especially  in  France,  the 
only  country  where  at  that  time  there  was  a  special  college 
of  surgeons — the  small  Brotherhood  of  St.  Come,  already 
alluded  to,  which  was  always  contending  against  the  faculty 
on  one  hand  and  against  the  barber-surgeons  on  the  other, 
with  varying  results,  and  wliich,  at  last,  sought  peace  with 
the  university  and  was  received  by  it.  This  took  place  in 
1515,  and  was  the  renaissance  of  surgery,  not  only  for 
Paris,  but  for  the  whole  world.  By  this  reunion  the  faculty 
acquired  authority  over  the  barbers,  who  were  admitted  to 
their  lectures  and  took  courses  in  anatomy  and  surgery, 
gradually  attaining  a  knowledge  which  entitled  them  to  be 
called  barber-surgeons ;  their  rights  were  not  curtailed,  but 
made  more  difficult  of  procurement,  for,  in  addition  to 
passing  their  initiation  for  tlie  privilege  of  becoming  barber- 


AMBKOISE    PARE.  123 

surgeons,  tliey  also  had  to  pass  an  examination  before  the 
pliysicians  and  the  two  surgeons  of  the  king,  at  Chatelet, 
for  the  right  to  practice  surgery.  The  surgeons,  as  the 
price  of  their  submission  to  the  faculty,  had,  beside  tlie 
university  privilege,  a  sort  of  su})remacy  over  the  barbers ; 
and  thus  it  happened  that  the  barbers  were  admitted  to  the 
rank  of  surgeons  at  St.  Come,  and  that  the  surgeons  of  St. 
Come  were  admitted  as  barber-surgeons  by  the  laculty  of 
medicine.  In  this  double  capacity  they  approached  nearer 
the  profession  of  medicine,  from  which  they  should  never 
have  been  separated,  while  surgery  became  an  art  which 
received  numerous  improvements.  We  must  now  devote 
a  little  time  to  the  consideration  of  at  least  two  or  three  of 
the  men  who  most  contributed  to  extend  and  elevate  it. 

Among  those  who  most  contributed  to  make  the  period 
of  which  we  are  now  speaking  a  glorious  one,  raising  him- 
self from  the  lowest  walks  of  life  to  the  attainment  of  the 
highest  professional  honors,  is  Ambroise  Pave,  whose  name 
will  never  die  while  the  art  of  surgery  is  taught.  Pare  was 
born  about  the  year  1510,  at  Laval,  of  poor  parents.  He 
was  an  early  apprentice  to  tlie  provincial  barber-surgeons, 
after  which  a  natural  ambition  for  improvement  led  him  to 
Paris  (about  the  year  1532),  where  he  studied  three  years 
at  the  Hotel-Dieu,  and  obtained  the  confidence  of  his 
teachers  to  such  an  extent  that  he  sometimes  operated  for 
them.  He  never  learned  Latin,  the  language  at  that  time 
of  tlie  books  and  of  the  schools.  Pare  was  most  fond  of 
recalling  his  hospital  experience ;  he  counted  it  among  the 
highest  honors  of  his  life  that  he  should  have  enjoyed  what 
he  there  did  enjoy,  and  gives  us  to  suppose  that  he  was  a 
favorite  upon  whom  peculiar  favors  were  conferred.  In 
one  of  his  writings,  a  physician  of  Milan  having  expressed 
astonishment  at  so  young  a  man's  knowledge,  he  remarks 
with  pride :  "  But  the  good  man  did  not  know  that  I  had 
been  house-surgeon  for  three  years  at  the  Hotel-Dieu  de 
Paris,"     The  functions   of  the  barber  apprentices  in  the 


124  THE   HISTORY    OF    MEDICINE. 

hospital  in  those  days  were  probably  to  make  dressings  and 
bleedings,  and  sometimes  post-mortem  examinations  ordered 
by  the  chiefs,  to  assist  the  latter  in  their  operations,  and  to 
act  in  case  of  emergency ;  in  other  words,  to  do  about  as 
the  internes  at  present  do.  They  probably  found  there  a 
precious  and  rare  opportunity  for  anatomical  dissection,  but 
it  does  not  appear  that  they  had  regular  clinical  instruction. 


Fig.  14.— Ambroise  Par*. 

(From  a  steel  engraving  of  the  original  painting  in  l"£c61e  de  Medecine  at  Paris.) 

Communication  between  master  and  pupil  depended  abso- 
lutely on  the  pleasure  of  the  former. 

In  1537  Pare  was  made  surgeon  to  the  Colonel-General 
of  Infantry,  Rene  de  Montijean,  with  whom  he  made  his 
first  campaign  in  Italy.  (This  was  in  the  army  which 
King  Francis  I  assembled  in  Provence  with  which  to  re- 
pulse the  invasion  of  Charles  V.)  He  had  never  seen  war 
nor  recent  gunshot  wounds,  and  only  knew  of  them  by 
what  he  had  read  in  the  writings  of  John  de  Vigo.     This 


pake's  abolition  of  boiling  oil.  125 

was  at  a  time  when  it  was  the  custom  of  surgeons  to  pour 
boUing  oil  into  every  amputation  or  other  wound  in  order 
to  check  haemorrhage ;  and  Fare's  experience  in  this,  his 
first  campaign,  put  him  in  the  way  of  his  first  discovery, 
— a  discovery  which  will  never  be  forgotten.  He  has 
recounted  in  his  Book  of  Arquebus  Wounds  and  in  his 
great  Apology  how  after  the  affair  of  Pas-de-Suze  he 
watched  the  other  surgeons,  dreaming  of  nothing  else  but 
to  imitate  them  as  far  as  he  could  ;  how  the  boiling  oil 
gave  out;  how  his  anxiety  about  it  prevented  him  from 
sleeping;  and  how  to  his  great  wonder  he  found  that  the 
woLuided  who  had  submitted  to  the  operation  suffered  more 
than  the  others.  This  set  him  to  thinking,  and  led  him,  a 
young  man  without  name  or  authority,  without  letters  or 
philosophical  studies,  to  observe,  to  reason,  and  to  combat 
a  doctrine  which  was  universally  admitted  and  which  the 
highest  surgical  authorities  of  the  day  sustained.  At  that 
time  all  authors  who  had  spoken  of  gunshot  wounds  con- 
sidered them  as  poisonous  and  complicated  with  burns ; 
consequently  they  gave  the  precept  to  cauterize  with  boil- 
ing oil  or  a  red-hot  iron,  and  at  the  same  time  to  administer 
certain  alexipharmics  which  should  serve  as  internal  anti- 
dotes. John  de  Vigo,  physician  to  Pope  Julius  II,  assures 
ns  that  the  danger  of  these  wounds  results  from  the  round 
formation  of  the  balls,  from  heat,  and  from  the  poisonous 
qualities  communicated  to  them  by  the  powder.  His 
theory  and  the  method  of  treatment  above  given  had  been 
adopted  without  contradiction  until  the  day  when  Pare 
dared  to  utter  the  first  protest  against  them. 

After  a  campaign  of  three  years,  in  which  he  lost  his 
master,  he  returned  to  Paris  and  married.  In  1543  he  was 
in  the  army  of  Perpignan,  in  the  service  of  de  Rohan, 
grand  lord  of  Brittany,  where  he  gave  continuous  proof  of 
his  sagacity.  It  was  after  this  campaign  that  his  reputa- 
tion, so  well  established  among  warriors  and  the  nobility, 
inspired  Sylvius  with  the  desire  of  seeing  him.     Pare  has 


126 


THE   HISTORY    OF   MEDICINE. 


recounted   how,  in   a   conversation    which    they   had    to- 
gether, he   insisted  upon  the  then  entirely  new  precept, 


jr^?^?**T^" 


Fig.  15.— Pliers,  Iron  for  Actual  Cautery,  and  Seton-needles. 

(From  the  surgical  works  of  Ambroise  Pare,  1641.) 


of  which  he  had  made  many  applications,  that  in  order 
to  extract  bullets  it  was  best  to  place  the  wounded  in 
the  position  in  which  they  were  at  the  moment  of  injury. 


fare's  reintroduction  of  the  ligature.         127 

Sylvius,  then  at  the  height  of  his  fame,  invited  the  young 
physician  to  dinner,  and  listened  to  him  with  great  attention 
while  he  explained  his  views  on  gunshot  wounds,  which 
made  such  an  impression  upon  the  mind  of  the  host  that 
he  besought  him  eagerly  to  write  them  out  and  make  them 
public.  Encouraged  by  this  advice  from  so  high  a  source, 
Pare  prepared  his  text,  illustrated  it,  and  in  the  year  1545 
brought  out  his  little  work,  which  marked  in  a  manner  so 
glorious  the  revival  of  French  surgery.  It  was  published 
by  Gaulterot,  the  sworn  bookseller  of  the  University  of 
Paris,  and  was  entitled  "77ie  Manner  of  Treating  Wounds 
made  hy  Arquebuses  and  oilier  Fire-arms^  and  those  made 
hy  Arrows^  Darts,  and  the  Like  ;  and  also  hy  Bums  made 
Especially  hy  Ounpowder.  Composed  by  Ambroise  Pare, 
Master  Barber-Surgeon  in  Paris." 

A  few  months  later  appeared  the  second  edition,  in 
which  he  still  recommended  the  actual  cautery  in  haemor- 
rhage ;  but  each  day  he  meditated  upon  the  subject,  and 
on  one  occasion  discussed  it  with  two  surgeons  of  St. 
Come,  submitting  to  them  the  idea  that,  since  ligatures 
were  applied  to  veins  and  arteries,  and  to  recent  wounds, 
there  was  nothing  to  prevent  their  being  equally  applied 
to  amputations.  Both  agreed  with  him,  and  opportunity 
soon  presented  itself  at  the  siege  of  Damvilliers,  when  a 
gentleman  had  his  leg  crushed  by  a  shot  from  the  fortress. 
Pare  made  an  amputation,  omitting  for  the  first  time  the 
use  of  the  cautery,  and  had  the  happiness  to  save  his 
patient,  who,  full  of  joy  at  having  escaped  the  red-hot  iron, 
said  he  had  got  clear  of  his  leg  on  very  good  terms.  This 
was,  in  truth,  the  actual  renaissance  of  surgery,  wliich  had 
been  to  that  time  a  torture,  but  which  became  thereafter  a 
blessed  art.  It  was  a  barber-surgeon  who  produced  the 
double  marvel.     This  took  place  in  1552. 

In  1554,  after  other  campaigns.  Pare  was  made,  without 
examination.  Master  of  the  College  of  St.  Come,  and  in 
1559  was  included  among  the  surgeons  of  King  Henry 


128  THE   HISTORY   OF   MEDICINE. 

II  (who  was  killed  in  a  tourney,  in  Paris,  in  1559), 
which  position  he  retained  with  Francis  II  and  Charles 
•IX.  The  latter  raised  him  to  the  highest  position  among 
his  surgeons,  and  King  Henry  III  retained  him,  which 
caused  the  witty  and  true  remark  that  the  kings  of  France 
transferred  him  to  their  successors  as  a  legacy  of  the  crown. 
]\£any  anecdotes  are  related  of  Pare  to  show  the  remark- 
able esteem  in  which  he  was  held  by  public  and  private 
citizens.  For  instance,  in  October,  1552,  one  of  the  most 
eminent  generals  of  Charles  V  laid  seige  to  the  city  of 
Metz,  and  the  emperor  came  in  person  to  join  the  army. 
Within  the  walls  of  this  beleaguered  city  were  gathered 
nearly  all  the  nobility  and  princes  of  France.  The  city 
was  defended  by  the  Duke  of  Guise,  and  the  besieged 
soldiers  were  at  that  time  suffering  alike  from  the  attacks 
of  the  enemy,  the  results  of  the  siege,  and  the  rigors  of 
a  frightful  winter.  The  duke  had  established  two  hos- 
pitals for  the  soldiers,  and  had  put  into  requisition  the 
barber-surgeons  of  the  city,  giving  them  money  with  which 
to  furnish  their  supplies.  But  these  surgeons  were  sadly 
incompetent  against  the  combination  of  unfavorable  cir- 
cumstances, consequently  nearly  all  the  wounded  perished, 
and  a  horrible  suspicion  was  roused  among  the  soldiers 
that  they  had  been  poisoned.  Under  these  circumstances 
the  duke  dispatched  one  of  his  captains  to  the  king  to 
say  that  the  place  could  hold  out  for  ten  months,  and 
asked  at  the  same  time  for  fresh  medicine.  The  king 
sent  for  Pare,  gave  him  money,  directed  him  to  take  all 
the  medicine  he  thought  necessary,  and  furnished  him  a 
letter  to  Marshal  St.  Andre,  who  commanded  in  Verdun, 
and  who  bribed  an  Italian  captain  for  fifteen  hundred 
crowns  to  introduce  into  the  besieged  city  the  celebrated 
surgeon.  The  expedition  was  perilous,  and  Pare  himself 
would  have  willingly  remained  in  Paris.  But  he  entered 
Metz  on  the  8th  of  December,  at  midnight,  without  an 
accident.     Having   passed   already  sixteen  years  in  war, 


b9 


Fig.  16.— Swan's  Beak,  Used  fob  Dilating  the  Track  of  a  Wound 
AND  Extracting  a  Foreign  Body. 

(From  tlie  S)irgioaI  works  of  Amhroise  Pare,  1641.) 


130  THE   HISTORY   OF   MEDICINE. 

lie  was  known  to  the  chiefs  and  common  soldiers.  The 
day  after  his  arrival,  the  duke,  who  knew  how  to  strike 
the  imagination,  presented  him  on  the  ramparts  to  all 
the  princes,  lords,  and  captains,  who  embraced  and  re- 
ceived him  with  clamor.  By  the  soldiers  he  was  received 
with  shouts  of  triumph.  "We  shall  not  die,"  they  ex- 
claimed, "even  though  wounded;  Pare  is  among  us!" 
From  this  time  the  defense  was  conducted  with  renewed 
vigor,  and  it  has  been  universally  conceded  that  to  the 
presence  of  this  single  man  the  city  was  indebted  for 
its  salvation.  The  siege  itself  was  not  raised  until  after 
a  terrific  conflict.  On  the  very  day  of  Fare's  arrival  he 
began  to  treat  the  leg  of  one  of  the  prominent  officers, 
who  for  four  days  had  been  in  charge  of  a  charlatan, 
and  had  suffered  horrible  tortures.  The  next  day  he 
decided  to  trephine  another,  who  had  been  struck  on  the 
head  by  a  fragment  of  stone,  and  who  had  been  insen- 
sible for  fourteen  days.     Both  patients  recovered. 

The  little  brotherhood  of  surgeons  of  St.  Come  were 
ready  to  seize  on  every  circumstance  which  might  redound 
to  their  advantage,  and  desired  to  have  within  their  ranks 
the  man  who  enjoyed  such  great  renown.  They,  there- 
fore, admitted  him  to  an  examination,  in  spite  of  the  stat- 
ute which  required  that  tlie  candidate  should  understand 
Latin,  and  in  spite  of  opposition  by  the  professors  of  the 


Description  of  Fig.  17. — A,  the  instrument  named,  on  account  of  its  figure, 
lizard's  beak;  in  Latin,  ^^  rostrum  lacerti."  It  is  used  to  extract  balls  which  have 
been  flattened  or  imbedded  in  bone.  A  displays  particularly  the  cannula.  £,  hinge, 
by  means  of  which  the  lizard's  beak  is  opened  and  closed  as  much  or  as  little  as  the 
surgeon  wishes.  C,  the  rod  which  opens  and  closes  the  lizard's  beak.  When  drawn 
upon  it  closes  and  when  pushed  it  opens  the  instrument.  B,  D.  dilator  and  mirror ; 
in  Latin,  ^^  dilatatorinm,  speculum."  The  instrument  is  somewhat  roughened  and 
dentated  in  order  to  take  a  firm  hold  of  whatever  it  grasps.  It  may  serve  two  pur- 
poses :  first,  to  dilate  and  enlarge  the  wound  so  that  it  may  be  seen  to  the  bottom, 
and  also  to  make  way  for  some  instrument,  as  pincers  or  crow's  beak,  and  to  grasp 
more  easily  and  withdraw  the  foreign  body ;  secondly,  it  may  itself  serve  to  extract 
the  foreign  body, — e.g.,  a,  double-headed  ball ;  5,  a  small  chain  ;  c,  c,  some  pieces  of 
mail.  E,  E,  crane's  beak;  in  Latin,  ^^rostmm  grninum."  H,  H,  duck's  beak; 
in  Latin,  ^'- rostrum  anserinum."  K,  sound.  L,  ball-extractor  without  cannula. 
M,  cannula  with  handle. 


w'.TG   17.— Various  Instrumknts  for  the  Kxtraction  ok  Hai,i,s. 

(From  theWoHs  on  Chiiurgmi-.,  by  Jacques  Guillemeini.  cliinirgeon  ordinary 
to  the  King  of  France,  WW.) 


132  THE   HISTORY   OF   MEDICINE. 

university.  They  not  only  admitted  him  to  all  their  de- 
grees, but  awarded  him  a  reception, — a  hitherto  unknown 
honor. 

Pare  in  his  time  met  with  a  success  whicli  to-day  would 
be  pronounced  extraordinary.  He  seemed  to  inspire  the 
wounded  with  the  utmost  confidence,  and  to  possess  great- 
ness and  firmness  of  character  in  tlie  highest  degree.  It  is, 
perhaps,  even  more  extraordinary  that  with  so  strong  a 
cliaracter  he  should  have  so  long  retained  favor  at  court. 
In  the  midst  of  the  excitement  of  camps,  and  a  very  ex- 
tended practice,  he  found  time  to  read  all  that  had  been 
published  on  his  art,  and  to  compose  himself  a  great 
number  of  works,  enriching  all  branches  of  surgery. 
Instead  of  keeping  secret  his  inventions,  as  was  the 
custom  of  the  time,  lie  made  them  as  public  as  possible, 
saying,  in  the  preface  of  liis  large  work  on  surgery 
"  For  my  part,  I  liave  dispensed  liberally  to  everybody 
the  gifts  that  God  has  conferred  upon  me,  and  I  am 
none  the  worse  for  it ;  just  as  the  light  of  a  candle  will 
not  diminish  no  matter  how  many  may  come  to  light 
their  torches  by  it." 

Besides  his  smaller  treatises,  his  large,  collective  works 
passed  through  a  number  of  editions,  and  were  everywhere 
reprinted  and  studied.  Not  only  was  he  great  in  surgery, 
but  he  attained  a  high  degree  of  expertness  in  midwifery. 
Among  other  things,  he  restored  the  forgotten  practice  of 
podalic  version  in  cases  wliere  this  procedure  is  necessary. 
He  died  in  1590. 

The  doctrine  of  Pare  on  gunshot  wounds  was  rapidly 
disseminated.  From  1550,  Maggi,  of  Bologna,  advocated 
it  without  giving  credit  to  its  real  author,  and  sustained  it 
by  decisive  experiments.  He  observed  that  none  of  the 
wounded  felt  any  lieat,  and  that  the  torn  portions  of  their 
clotliing  showed  no  trace  of  fire ;  and  he  shot  balls  through 
packages  of  powder  witliout  setting  tliem  on  fire.  At  the 
same  time  Lange  spread  tliis  view  in  Germany,  and  Botal, 


Fig.  18.— Specumims  foii  the  Mouth  and  Womb,  etc. 

A,  A,  nioutli-inirror  ;  in  liatin,  '■'■speculum  ori.i.''  B,  toiijiiu'-depipssor.  C, 
C,  branches  to  be  i)liioed  iinrter  the  chin.  G?,  O,  instrument  for  retrenching 
elongated  uvtila.  O.  O.  O,  wonib-niirror ;  in  Latin,  '■■  speculum  rnatricis."'  ■ui,  m, 
artilicnl  tooth  oT  ivory  or  gold,  attiiched  by  sinnll  gohl  threads.  ii,  ?J,  three 
artificial  teeth  joined  together  and  attached  by  gold  tliri';uls  to  the  adjacent 
teeth  on  each  side. 


(From  the  Wurk.-i 


Cfiinirifftif.  liy  .Jneipies  Gnillcnienn.  (_'liirui"ff(.''in  'n-dinnr^ 
to  tlie  King  uf  Fnince.  ICW.) 


134  THE   HISTORY    OF    MEDICINE. 

of  Turin,  took  it  up  (withholding,  however,  the  true 
author's  name). 

While  Ambroise  Pare  did  not  disdain  to  act  as  ac- 
coucheur, it  was  his  friend  and  pupil,  Jacob  Guillemeau 
(1550-1613),  who,  in  the  sixteenth  century,  most  occupied 
himself  with  the  practice  of  obstetrics.  We  owe  to  Guil- 
lemeau the  first  improvements  that  the  moderns  made  in 
this  art ;  for  instance,  the  proposition  to  rapidly  and  arti- 
ficially terminate  parturition  in  cases  of  considerable  haem- 
orrhage or  when  the  woman  is  taken  Avith  convulsions 
during  labor.  Guillemeau  supported  this  practice  on  the 
authority  of  Hippocrates,  and  operated  on  a  great  number 
of  patients,  proving  its  value  and  the  danger  of  its  neglect. 

The  Csesarean  operation  was  known  to  the  ancient 
Greeks  and  Romans,  but  had  been  abandoned  during  the 
Middle  Ages.  It  remained  for  the  accoucheurs  and  svu'- 
geons  of  the  sixteenth  century  to  re-establish  it.  Among 
others,  E-ousset,  physician  to  the  Duke  of  Savoy,  who  rec- 
ommended it  very  warmly,  reported  several  cases  where  it 
had  a  happy  issue  for  both  mother  and  child.  He  even 
reported  the  most  remarkable  case  of  all, — that  of  a  woman 
who  was  six  times  delivered  by  this  operation,  and  who 
perished  in  the  seventh  confinement,  because,  as  he  states, 
the  surgeon  who  had  been  accustomed  to  operate  on  her 
was  absent.     Unfortunately,  this  case  is  not  authenticated. 

Nothing  shows  better  how  the  art  of  observation  and 
accurate  description  of  phenomena  had  progressed  at  the 
time  of  the  revival  of  letters  than  tlie  number  of  new  dis- 
eases of  which  the  authors  of  that  period  make  mention. 
Then,  for  the  first  time  did  one  read  of  whooping-cough, 
miliaria,  scurvy,  plica  polonica,  syphilis,  and  rapliania.  It 
is  scarcely  credible  that  these  diseases  fell  upon  Europe  at 
this  particular  time.  It  is  more  probable  that  they  had  a 
more  ancient  existence  and  were  not  recognized. 

Even  to-day  medical  men  are  divided  in  their  own 
opinions  on  the  origin  of  syphilis,  some  believing  that  it 


[Sstf\':me.ks  frqpres  a  .eycrifpER  u:.s 


Fig.  19.— Amputation  Insthuments. 

This  plate  shows  knives,  saws,  and  pliers,  and  also  those  by  which  haemorrhage 
was  arrested  without  use  of  the  cautery. 

(From  tlie  fVurlci  on  Cliinivi/erie,  by  Jncqnes  Guillemeau,  oliirurgeon  ordinary 
to  the  King  of  France,  1()49.} 


136  THE   HISTORY   OF   MEDICINE 

was  developed  spontaneously  in  Europe  toward  the  close 
of  the  sixteenth  century,  others  that  it  was  imported  from 
the  New  World,  others  that  it  had  a  most  ancient  origin, 
and  others  yet  that  it  represented  a  degenerated  form  of 
leprosy. 

Certain  it  is  that  syphilis  appeared  almost  simulta- 
neously in  all  parts  of  Europe, — at  Bologna,  Halle, 
Bninswick,  in  Lombardy,  Apulia,  Auvergne,  and  so  on. 
Leonicenus  attributed  this  sudden  outbreak  to  an  ex- 
traordinary inundation  that  occurred  in  all  parts  of  Italy 
toward  the  close  of  the  fourteenth  century,  and  supported 
his  views  witli  the  authority  of  Hippocrates  and  Galen, 
Others  attributed  it  to  astrological  influence;  while  still 
others  regarded  it  as  a  scourge  of  God  with  which  to 
punish  men  and  turn  them  away  from  unbridled  liber- 
tinism. Fallopius  thought  venereal  disease  was  engen- 
dered by  the  poison  which  the  perfidious  Neapolitans  had 
thrown  into  the  wells  from  which  the  French  drew  their 
water.  These  wild  views. simply  indicate  the  spirit  of  the 
age.  Oviedo  published  in  1545  a  history  of  the  West 
Indies,  in  which  he  states  that  syphiHs  originated  in  Amer- 
ica. He  held  that  when  Columbus  returned  from  his 
second  expedition  to  the  New  World,  in  1496,  his  men 
enlisted  under  Gonsalvo  de  Cordova  to  go  and  fight  the 
French,  who  had  invaded  the  Kingdom  ot  Naples,  and 
that  they  communicated  to  the  French  and  Neapolitans 
tlie  disease  which  they  had  brought  from  San  Domingo. 
Unhappily  for  his  veracity,  it  is  certain  that  syphilis  broke 
out  in  Naples  at  least  two  years  before  tlie  arrival  of  the 
Spanish  fleet.  It  is  equally  certain  that  at  none  of  tlie 
points  at  which  Columbus  touched  on  his  return  from  his 
first  expedition  was  there  any  manifestation  of  syphilis 
for  years. 

At  this  time  the  venereal  disease,  so-called,  included 
those  conditions  which  we  now  diff'erentiate  under  the 
names  of  sypliiUs,  chancroid,  and  gonorrhoea, — a  confusion 


KiG.  20.— Different  Forms  of  Trephines  and  Pliers. 

(From  the  »''«■/,•«  nn  Cliiiuriinie.  by  Jacques  Gnilleineau,  chinirgeon  ordinary 
to  the  King  of  France.  1649.) 


138  THE    HISTORY   OF   MEDICINE. 

of  diseases  which  persisted  even  up  to  the  time  of  John 
Hunter.  It  is  worth  while  to  publish  this  fact,  since 
writers  of  two  or  three  hundred  years  ago  may  not  have 
meant  by  the  term  "  syphilis  "  just  what  we  would  mean 
to-day.  Without  going  into  this  question  here,  it  is 
enough  to  say  that  one  who  reads  intelligently  may  see  in 
the  Sacred  Scriptures  unmistakable  allusions  to  this  dis- 
ease. If  the  statements  of  David,  as  contained  in  the 
Psalms,  are  reliable,  he  was  himself  a  serious  sufferer  from 
it.  The  ancient  Greek  and  Arabian  physicians  make  men- 
tion of  lesions  which  could  only  be  attributed  to  this  dis- 
ease ;  and  tlie  Latin  satirists,  like  Horace  and  Juvenal, 
describe  symptoms  of  a  certain  kind  as  being  the  fruit  only 
of  shameful  practices. 

It  is  most  likely  that  the  sudden  appearance  of  syphilis 
in  nearly  all  parts  of  Europe  at  about  the  same  time,  which 
has  been  regarded  as  so  extraordinary,  can  be  explained  by 
the  clearer  distinctions  physicians  began  to  make  between 
symptoms  of  this  disease  and  those  of  leprosy.  Arrange- 
ments for  the  cure  of  lepers  were  very  complete,  and  such 
syphilitic  patients  as  responded  kindly  to  the  treatment 
thereby  established  themselves  in  a  very  different  category 
of  disease. 

The  first  writer  to  systematically  consider  venereal  dis- 
ease was  Astruc,  who  was  born  in  Languedoc  in  1684  and 
died  in  1766.  He  was  the  principal  advocate  of  the  view 
that  syphilis  had  an  American  origin,  in  which  view  he 
was  bitterly  opposed  by  Sanchez,  a  Portuguese  physician, 
who  collected  a  large  amount  of  evidence  to  the  effect  that 
its  first  ravages  were  observed  in  Italy. 

Summing  up  this  whole  matter,  we  may  agree  with 
Jourdan,  who  has  examined  all  the  opinions  of  these 
writers,  and  who,  in  his  treatise  published  in  1826, 
concluded  that  all  symptoms  which  had  been  hitherto 
connected  with  syphilis  had  been  known  and  described 
from    the   remotest  antiquity,  but   were  not  supposed   to 


THE    OCCULT    SCIENCES.  139 

proceed  from  a  common  source,  and  to  be  attached  to 
the  same  cause,  until  after  the  close  of  the  fifteenth 
century.     - 

THE    INFLUENCE    OF   THE    OCCULT    SCIENCES    ON    THE    MEDICINE 
OF   THIS   PERIOD. 

Most  of  the  partisans  of  occult  science  were  restless 
minds,  such  as  are  found  in  all  ages,  who  chafed  under 
the  yoke  of  authority,  and  who  practiced  as  well  as 
deduced  their  lines  of  tliought  and  conduct  in  accordance 
with  their  own  ideas.  Some  of  these  men  did  not  lack 
in  sagacity,  imagination,  or  audacity,  but  almost  all  of 
them  lacked  in  consistency  of  idea  and  dignity  of  thought. 
Most  of  them  lived  isolated  lives,  apart  from  each  other 
and  from  the  rest  of  the  world,  and  were,  to  a  large 
extent,  what  we  would  now  regard  as  "cranks."  While 
tliey  made  a  wide  departure  from  accredited  doctrine, 
they  depended  upon  imagination  rather  than  upon  reason. 
This  happened  to  be  a  period,  however,  when  such  men 
achieved  great  notoriety, — more  so  than  the  same  class 
of  individuals  have  done  since  their  time. 

Cornelius  Agrippa  (born  in  1486)  was  an  early  pro- 
moter of  occult  science.  He  came  of  a  noble  family  of 
Cologne,  received  the  best  education  of  his  time,  was  a 
man  of  varied  attainments,  great  inconsistency  in  conduct, 
and  a  caustic  humor  which  everywhere  made  him  enemies 
and  prevented  him  from  having  any  settled  abode.  He 
wandered  from  place  to  place,  sometimes  honored  with 
the  favor  of  the  nobility  and  sometimes  plunged  into 
extreme  misery.  He  early  became  a  secretary  in  the 
court  of  Emperor  Maximilian  I,  and  under  that  monarch 
distinguished  himself  in  the  army  by  such  bravery  as  to 
win  him  spurs  as  a  knight.  Soon  disgusted  with  the 
profession  of  arms,  he  devoted  himself  to  law  and  medi- 
cine, but  his  intemperate  pen  soon  drew  him  into  quarrels 
and  persecution.     At  Dole  he  fell  out    with    the  monks; 


140  THE    HISTORY    OF   MEDICINE. 

at  Paris  and  Turin  he  compromised  himself  with  the 
theologians;  at  Metz  he  inclined  the  animosity  of  the 
Jacobins  for  attacking  the  prevailing  opinion  that  St. 
Ann  had  three  husbands.  He  became  a  vagabond  and 
almost  a  beggar  in  Germany,  England,  and  Switzerland, 
and  then  went  to  Lyons,  where  the  mother  of  Francis 
I,  who  was  then  Queen  Regent,  made  him  her  physi-' 
cian.  He  soon  lost  fjivor  here,  and  was  disgraced  and 
banished;  then  he  went  to  the  Low  Countries,  where  he 
was  imprisoned  on  account  of  his  treatise  on  The  Vanity 
of  the  Sciences.  Afterward  he  returned  to  Lyons,  was 
imprisoned  anew,  for  an  old  libel  against  his  former 
patron,  and  finally  died  in  the  hospital  of  Grenoble,  in 
L535,  at  the  age  of  about  fifty.  His  treatise  on  The 
Vanity  of  the  Sciences  made  him  most  trouble,  and 
showed  best  both  his  bitterness  of  spirit  and  the  extent  of 
his  learning.  Herein  he  laid  down  the  paradox,  which  was 
later  renewed  and  sustained  by  Rousseau,  that  there  is 
nothing  more  pernicious  and  injurious  to  common  life, 
or  more  pestilential  to  the  salvation  of  souls,  than  the 
arts  and  sciences.  He  founded  this  thesis  on  Scriptural 
authority,  and  supported  it  by  profane  testimony. 

The  conclusions  Avhich  Agrippa  drew  were  not  so 
strange  to  the  eyes  of  his  contemporaries  as  they  are  to 
ours.  Long  before  him,  men  of  character  and  attain- 
ments, such  as  Pic  de  la  Mirandola  and  Bessarion,  had 
attempted  to  introduce  the  Platonic  idea,  that  the  best 
means  of  acquiring  science  and  truth  were  introspective. 
They  were,  moreover,  persuaded  that  a  great  number  of 
phenomena  and  events  have  their  origin  in  astral  influ- 
ences.   From  this  system  to  the  extravagance  of  the  Cabal* 

*  Cabal,  or  Kabbalah:  A  theosophlcal  or  mystic  speculative  system,  of  Hebrew 
origin,  which  flourislied  from  the  tenth  to  the  sixtceuth  century.  It  included  a 
mystic  theosophy  and  cosmogony,  attributing  to  deity  neither  will,  desire,  nor 
action,  but  teaching  that  from  it  emanated  wisdom,  grace,  intellect,  power,  beauty, 
firmness,  and  other  attributes.  It  also  ascribed  hidden  meanings  to  the  sacred 
Hebrew  writings  ami  words.     Even  in  the  letters  and  forms  of  the  sacred  words 


CORNELIUS    AGRIPPA.  141 

is  but  a  step;  indeed,  the  Christian  doctrine,  that  events  and 
phenomena  are  influenced  by  the  direct  intervention  of 
the  deity  or  of  the  devil,  is  but  a  small  transposition. 
The  cabalistic  theory,  summed  up,  was  that  all  the  events 
of  life  and  all  tlie  plienomena  of  nature  proceed  from 
influences  which  gods,  devils,  or  the  stars  exercised  on 
the  "archetype" — that  is,  on  the  essential  spirit,  or  sub- 
stance. He  who  could  witlidraw  his  spirit  possessed  super- 
natural faculties.  The  day  and  the  hour  of  birth,  according 
to  this  view,  were  under  tlie  domination  of  particular  stars, 
and  each  of  the  principal  members  of  the  body  was  supposed 
to  correspond  with  some  planet  or  constellation.  This  is 
the  fundamental  idea  underlying  the  pictures — which  are 
still  to  be  found  on  almanacs  used  by  quack-medicine 
firms — of  tlie  individual  whose  interior  is  so  completely 
and  uncomfortably  exposed,  while  around  him  are  arranged 
the  signs  of  the  zodiac,  with  indications  as  to  which  part 
of  the  body  is  governed  by  each. 

Occult  philosophy,  built  upon  this  foundation,  was 
divided  into  four  branches:  theosophy^  to  which  a  man 
raised  himself  by  prayer ;  7nagic,  or  the  art  of  controlling 
demons ;  astrology^  or  the  art  of  reading  future  events  by 
the  stars ;  and  alclieiny,  which  teaches  the  secret  of 
extracting  the  essence  or  the  archetype  of  substances, — 
'/.e.,  virtually  the  secret  of  the  philosopher's  stone,  by 
which  metals  were  to  be  transmuted  and  then  abolished. 

And  so  the  errors  of  science,  the  prejudices  of  the 
superstitious,  the  excitement  of  the  religious,  and  the 
cupidity  of  the  rich  and  powerful,  all  concurred  to  prop- 
agate the  faults  of  the  cabal  at  the  close  of  the  Middle 
Ages.  Never*  were  there  seen  so  many  sorcerers,  astrol- 
ogists,  and  alchemists;  never  were  prophecies,  visions,  and 
prodigies  so  common.     Whatever   happened,  it  was  pre- 

tlie  followers  of  the  cabal  pretended  to  find  wonderful  and  hidden  meanings ; 
hence  the  modern  expression  "cabalistic."  The  teaeliine^s  of  the  cahal  were 
esoteric,  of  course,  and  inculcated  mysticism  and  occultism  in  everything,  but 
appear  to  have  been  more  or  less  influenced  by  neoplatonlsm. 


142  THE    HISTORY    OF    MEDICINE. 

tended  that  it  had  been  announced  by  some  previous  sign, 
or  that  it  was  a  revelation  of  the  future.  This  particular 
kind  of  folly  persisted  in  Germany  longer  tliaii  in  any 
otlier  part  of  the  world.  Even  Martin  Luther  seemed  to 
share  many  of  the  cabalistic  views,  and  his  alleged 
struggle  with  the  devil,  his  adventure  with  the  inkstand, 
and  so  on,  contributed  much  to  spread  them,  and  were, 
perhaps,  the  most  prominent  illustrations  of  their  general 
acceptance.     Surely,  these  icere  the  Dark  Ages. 

Jerome  Cardan  was  born  at  Pavia  in  1501.  His  life, 
like  that  of  Agrippa,  was  one  of  vicissitude  and  incon- 
sistency. Being  the  idol  of  his  mother  and  the  detestation 
of  his  father  produced  a  peculiar  effect  upon  his  charac- 
ter. When  he  began  to  study  he  made  rapid  progress, 
and  at  the  age  of  twenty-two  was  able  to  discuss  publicly 
all  questions.  About  two  years  later  he  received  his  doc- 
tor's hat.  He  practiced  medicine  in  various  places  until 
he  was  thirty-three,  and  was  then  made  professor  of  math- 
ematics at  Milan.  ?Ie  occupied  this  position  but  two  years, 
then  traveled  in  Germany,  France,  and  England,  and 
returning  to  Italy  was  imprisoned  for  debt  in  Bologna, 
and  finally  obtained  a  pension  from  the  pope,  in  Rome, 
where  he  died  in  1556.  He  was  a  man  of  great  attain- 
ments and  sagacity;  his  literary  style  was  dignified,  nnd,  if 
he  had  not  developed  such  a  taste  for  the  marvelous,  such 
inconceivable  credulity  and  superstition,  and  such  canity 
and  boasting,  he  would  have  been  a  remarkable  character 
in  his  age.  Leibnitz  said  of  him :  "  Notwithstanding  his 
faults,  Cardan  was  a  great  man  and,  without  his  defects, 
would  have  been  incomparable."  He  wrote  extensively 
on  philosophy,  mathematics,  and  medicine.  Sometimes  he 
admitted  to  his  writings  the  most  absurd  statements  of 
visions,  etc.,  and  again  affirmed  that  he  had  never  devoted 
himself  to  cabalistic  art,  blamed  those  who  practiced  it,  and 
jeered  at  those  who  believed  in  it.  He  wrote  extensively 
on  chiromancy.     For  his  own  follies  and  misfortunes  he 


CARDAN.      PARACELSUS. 


143 


apologized,  attributing  them   all  to  the  influences  of  the 
stars. 

The  most  colossal  figure  in  this  collection  of  mediaeval 
charlatans  and  knaves  was  Paracelsus.  He  was  born  in 
1493,  near  Zurich,  of  a  well-to-do  family,  his  father  being  a 
physician.  He  had  a  good  preliminary  education,  and 
then  visited  the  various  universities,  or  rather  university 


Fia.  21.— Philip  Theophrastus  Paraoblsus. 

(From  an  old  engraving  by  Ridley.) 


towns ;  but,  instead  of  listening  to  the  professors,  Paracelsus 
associated  with  clever  women,  barbers,  magicians,  alchem- 
ists, and  the  like,  from  whom  lie  acquired  much  infor- 
mation. He  was  led  at  once  to  the  vagaries  of  the  cabal, 
and,  according  to  his  own  statement,  he  did  not  open  a 
book  for  ten  years.  He  neglected  his  studies  and  forgot 
his  Latin,  so  that  he  became  incapable  of  expressing  him- 


144  THE   HISTORY    OF   MEDICINE. 

self  in  that  language.  From  the  age  of  twenty-five  he 
became  a  hard  drinker,  and  this  habit  ultimately  worked 
his  ruin.  One  of  his  disciples  says  of  him  that  during  the 
two  years  which  he  passed  with  him  he  was  so  inclined  to 
drinking  and  debauchery  that  he  could  scarcely  be  seen  for 
an  hour  or  two  without  being  full  of  wine,  although  that 
condition  did  not  prevent  him  from  being  admired  by  every 
one  as  a  second  ^sculapius. 

At  this  time  Paracelsus  was  between  thirty-three  and 
thirty-five  years  of  age,  and  at,  apparently,  the  most  brill- 
iant period  of  his  life.  He  had  written  extensively  and 
with  emphasis  of  his  numerous  cures,  after  the  fashion  of 
charlatans  of  those  days, — and,  unfortunately,  of  to-day, — 
and  claimed  to  be  possessed  of  infallible  secrets  against  the 
most  intractable  diseases.  He  had  just  been  called  to 
Basel  to  the  chair  of  pliysic  and  surgery,  and  crowds  of 
curious  and  idle  persons  attended  his  lectures,  which  lie 
gave  in  the  vernacular,  and  not,  as  was  customary  in  those 
days,  in  Latin.  In  order  to  strike  his  auditors  with  aston- 
ishment, he  began  by  burning  the  works  of  Galen  and 
Avicenna,  and  then  reading  from  his  own  writings,  break- 
ing off  from  time  to  time  into  the  statement :  "  Know,  ye 
doctors,  that  my  hat  knows  more  than  you ;  that  my  beard 
is  more  experienced  than  your  academies.  Greeks,  Latins, 
Arabians,  French,  Italians,  Jews,  Christians,  and  Moham- 
medans, you  must  follow  me ;  I  shall  not  follow  you,  for  I 
am  your  monarch,  and  sovereignty  belongs  to  me."  As 
may  be  imagined,  his  professorship  was  not  one  of  long 
duration,  and  he  soon  liad  few  or  no  listeners.  In  conse- 
quence of  some  mishaps  he  left  Basel  quite  precipitately, 
his  departure  causing  no  such  sensation  as  his  arrival.  He 
then  resumed  his  nomadic  life,  and  we  find  him  at  Alsace 
in  1528,  at  Nuremberg  in  1529,  at  St.  Galle  in  1531,  at 
Mindelheim  in  1540,  and  in  the  following  year  at  Salzburg, 
where  he  died  in  the  hospital  at  the  age  of  forty-eight. 

Few  men   there  are  of  whom  so   much  good  and  so 


PARACELSUS.  145 

much  evil  has  been  written  as  of  Paracelsus.  Few  are 
there  of  whom  it  is  to-day  so  hard  to  judge,  since,  if  we 
refer  to  his  contemporaries,  they  disagree  completely  con- 
cerning him,  and  if  we  refer  to  his  own  writings  we  fall 
into  still  greater  chaos  and  have  to  abandon  the  attempt. 
His  writings  show  ideas  without  connection,  observations 
which  contradict  each  other,  and  phrases  which  defy  com- 
prehension. At  one  moment  he  gives  proof  of  admirable 
penetration,  at  the  next  simply  abject  nonsense. 

That  he  exerted  an  influence  upon  his  time  is  certain, 
but  that  this  influence  was  retrograde  rather  than  pro- 
gressive seems  quite  likely.  His  exact  duplicate  has 
probably  never  existed  since  his  time,  and  we  may  say 
that  never  was  there  another  man  like  Aurelius  Phillip- 
pus  Theophrastus  Paracelsus  Bombastus  ab  Hohenheim — 
his  full  name. 

Although  this  man  was  such  a  prominent  character 
in  his  day,  his  name  must  be  erased  from  the  list  of 
those  who  have  contributed  to  the  world's  progress.  He 
was  simply  a  pretended  reformer,  who  counted  as  nothing 
the  most  erudite  writings,  and  who  relied  solely  on  his 
own  experience.  He  had  the  most  profound  self-confi- 
dence, and  played  upon  the  creduUty  of  his  neighbors 
and  victims  with  the  toys  which  were  furnished  him  by 
the  prevalent  cabalistic  notions  of  the  day.  The  scliool 
which  he  would  have  founded  was  nothing  but  a  school 
of  ignorance,  dissipation,  and  boasting — a  school  of  medical 
dishonesty.  In  a  word,  it  was,  as  Renouard  has  said, 
"  a  school  of  wliich  Thessalus,  of  Tralles,  had  been  the 
Corypheus  in  antiquity,  which  Jolm  of  Gaddesden  re- 
vived in  the  Middle  Ages,  and  to  which  Paracelsus  gave 
a  new  development." 

While,  as  has  been  briefly  recounted,  the  partisans  of 
the  occult  sciences  strove  to  completely  overturn  the 
scientific  edifice  of  antiquity,  other  reformers,  more  sen- 


146  THE    HISTORY    OF   MEDICINE. 

sible  and  less  daring,  were  content  to  expose  its  defects 
without  attacking  it  in  its  entirety.  These  were,  for  the 
most  part,  enlightened  men,  and  at  the  same  time  free 
thinkers, — friends  of  progress,  and  not  of  destruction. 
During  the  sixteenth  century  these  men  were  few  in 
number,  but  at  least  three  or  four  of  them  deserve 
mention. 

John  Argentier  was  born  in  Piedmont,  and  taught 
in  Naples,  Pisa,  and  Turin.  He  did  not  hesitate  to  take 
issue  with  the  theories  and  statements  of  Galen,  and 
criticised  those  who  adopted  them  too  servilely.  Of  him 
it  may  be  said  that,  although  styled  a  reformer,  never- 
theless, he  kept  too  near  to  the  doctrines  of  those  against 
whom  he  inveighed  to  seriously  weaken  their  position. 

Leonard  Botal,  also  a  Piedmontese,  was  born  in  1530. 
First  a  surgeon  in  the  French  army,  he  later  became 
physician  to  the  kings  Charles  IX  and  Henri  III.  He 
was  the  first  to  recommend  frequent  and  general  blood- 
letting. Apparently  before  his  time  this  practice  was 
greatly  restrained.  He  carried  his  views  so  far  as  to 
maintain  that  an  infirm  old  man  should  be  bled  from 
two  to  six  times  a  year,  and  that  it  was  good  custom 
to  open  the  veins  of  healthy  individuals  every  six  months. 
He  wrote  a  remarkable  memoir  on  the  cure  of  disease 
by  blood-letting.  It  is  not  to  be  denied  that  he  obtained 
some  remarkable  success  with  his  copious  venesections, 
and  it  must  be  said,  in  his  defense,  that,  if  he  overdid 
it,  his  contemporaries  did  not  resort  to  it  often  enough, 
and  that  his  own  practices  were  instructive  to  others.  In 
his  writings  he  united  independence  and  energy  of  thought 
with  elegance  and  purity  of  style. 

Joubert  (1529-1583)  was  Cliancellor  in  the  University 
of  Montpellier  and  physician  to  King  Henri  HI.  He 
wrote  a  treatise  on  Popular  Errors,  which  had  an 
unheard-of  success.  In  less  than  six  months  there  were 
sold  nearly  five  thousand  copies,  which,  considering  the 


joubert's  "popular  errors."  141 

times,  constituted  a  prodigious  edition.  For  one  thing, 
it  was  written  in  the  common  tongue,  and  so  placed 
within  the  reach  of  all.  It  was  also  diversified  with 
anecdotes  and  jokes,  some  of  which  were  not  of  the  most 
delicate  character;  in  fact,  the  author  endeavored  to 
atone  for  some  of  its  salacity  by  dedicating  it  to  Queen 
Marguerite.  He  really  proposed  for  his  main  purpose  a 
serious  and  useful  one, — namely,  that  of  combating  preju- 
dices which  were  both  injurious  and  ridiculous.  Although 
we  may  make  light  of  Joubert's  treatise,  it  certainly 
achieved  a  useful  end  by  dissipating  a  multitude  of 
errors,  giving  information  to  those  who  could  scarcely 
get  it  as  well  from  any  other  source.  That  it  was  full 
of  defects  is  simply  another  form  of  saying  that  it  was 
published  in  the  middle  of  the  sixteenth  century. 

It  was  during  this  period  of  which  we  have  written 
that  the  separation  of  the  priesthood  from  medicine  was 
completed.  From  the  sixteenth  century  celibacy  was  not 
obligatory  on  physicians  in  the  Kingdom  of  France,  and 
they  no  longer  enjoyed  ecclesiastical  benefices.  At  this 
time,  too,  surgery,  which  had  naturally  been  separated 
from  medicine,  began  to  approach  it,  the  combination 
thus  gradually  brouglit  about  inuring  to  the  benefit  of 
all  concerned.  From  now  on,  the  professors  of  St.  Come 
were  on  the  same  level  as  the  professors  of  the  university, 
and  enjoyed  equal  privileges.  Institutions  for  instruction 
in  medicine  increased,  and  those  whicli  already  existed 
were  developed.  Amphitheaters  for  dissection  were  o[)en 
in  every  city  in  Europe.  Hospitals  and  dispensaries  were 
established  alongside  the  schools,  and  by  the  various 
governments  more  attention  was  paid  to  the  protection 
of  the  public  from  imposition,  and  to  the  amelioration 
of  every  evil  affecting  either  public  or  private  health. 


CHAPTER  VI. 

AOK  OF  Renovation  {continued). — Student-life  During  the  Fifteenth  and 
Sixteenth  Centuries.  Ceremonials  Previous  to  Dissection. — Reform  Period  : 
The  Seventeenth,  Eighteenth,  and  Nineteenth  Centuries.  Modern  Realism 
in  Medicine  and  Science.  Introduction  of  the  Cell-doctrine.  Discovery 
of  the  Circulation.  William  Harvey,  1578-1637.  Malpighi,  1628-1694. 
Leeuwenhoek,  1632-1723.  Correct  Doctrine  of  Respiration.  Discoveiy  of 
the  Lymphatic  Circulation.  The  Nervous  System.  Discovery  of  Cinchona. 
Development  in  Ohstetric  Art,  in  Medical  Jurisprudence,  in  Oral  Clinical 
Teaching.  Van  Helmont,  1578-1644. — The  latroehemical  System :  Le  Boe, 
1614-1672.      Thomas  Willis,  1622-1675. 

For  a  long  time  tlie  Italian  universities  held  the  first 
rank;  next  came  the  French;  and  last  the  German, 
although  all  were  well  attended.  The  most  famous  were 
the  medical  faculties  of  Bologna,  Pisa,  Padua ;  then  Paris, 
Montpellier,  and,  finally,  Basel. 

A  little  of  what  concerned  the  student-life  of  this 
period  may  not  be  amiss.  The  students  chose  the  rector 
and  officers  of  the  universities,  sometimes  even  the  teach- 
ers, and  assisted  in  determining  the  curriculum  of  study, 
the  execution  of  which  they  watched.  In  some  of  the 
Scotch  universities  even  now  the  students  choose  the 
rector. 

The  students  were  divided,  usually  according  to  coun- 
try, into  bodies  denominated  "vm^ions"  (some  having 
special  seals),  which  were  the  parents  of  the  present  stu- 
dent-corps in  German  universities.  Certain  representa- 
tives, known  as  vice-rectors,  were  chosen  from  each  of 
these  corps  and  constituted  a  so-called  college  of  rectors 
which  negotiated  with  the  officials  of  the  State,  and  pos- 
sessed a  power  that  was  preserved  until  the  end  of  tlie 
sixteenth  century. 

The  poorer  class  of  students  passed  from  one  school  to 

another,   supporting   themselves   by  singing,   begging,   or 

stealing,  and   were   sometimes   guilty  of  great   barbarities. 

The  younger  scholars,  called  "Schiitzen,"  were  compelled 

(148) 


STUDENT-LIFE    IN    MIDDLE    EUROPE.  149 

to  perform  most  menial  duties  for  their  older  comrades,  the 
"Bacchaiiten," — much  like  the  system  of  fagging  still  in 
vogue  in  English  grammar-schools ;  and  when  the  bac- 
chantes were  admitted  to  the  university  proper  they  were 
required  to  pass  through  an  initiation,  or  hazing,  which 
eclipsed  anything  known  in  these  days ;  indeed,  the  antiq- 
uity of  fagging  may  be  traced  back  even  to  the  philosophic 
schools  of  Athens.  The  habits  of  the  traveling  scholars 
led  many  of  them  into  dissolute  and  vicious  ways,  though 
some  attained  respectable  positions, — possibly  even  emi- 
nence. The  students  who  were  better  situated  financially^ 
for  the  most  part  entered  the  Italian  universities. 

Already  mention  has  been  made  of  the  enormous  num- 
ber of  students  congregated  during  this  age  in.  Bologna 
and  in  Naples.  In  the  small  University  of  Wittenburg 
there  were,  in  1520,  only  about  six  hundred  students;  in 
Erfurt,  three  hundred,  and  this  number  dwindled  two 
years  later  to  fifteen;  in  1500  Leipzig  had  four  hundred 
students ;  at  the  same  time  there  were  about  seven  thou- 
sand in  the  University  of  Vienna.  Students  and  teachers 
migrated  from  one  place  to  another,  and  faculties  were  con- 
stantly changing.  Great  teachers  were  received  with  great 
ceremony.  Bitter  struggles  and  disputes  between  teachers 
sometimes  occurred;  it  is  related  of  Pistorius,  who  died  in 
1523,  and  Pollicli,  deceased  in  1513,  that  they  conceived  a 
violent  enmity  toward  each  other  because  of  antagonistic 
views  relative  to  the  epidemic  or  contagious  character  of 
syphilis,  and  both  ultimately  left  Leipzig  for  other  schools. 

Some  curious  customs  prevailed.  In  teaching  anatomy, 
while  the  learned  teachers  explained  the  parts  as  exposed, 
the  dissections  were  left  to  barbers  as  being  unworthy  of 
an  educated  medical  gentleman.  While  the  cadavers  were 
mainly  the  corpses  of  executed  criminals,  it  was  thought 
that  before  and  after  each  special  dissection  religious  cere- 
monies were  appropriate,  and  such  were  often  held ;  it  was 
also  believed  that  all  wlio  came  in  contact  with  such  a 


160  THE   HISTORY   OF   MEDICINE. 

corpse  would  be  made  disreputable  unless  it  were  itself 
first  made  reputable ;  hence  the  professors  first  read  aloud 
a  decree  to  that  eff*ect  from  the  magistrate,  and  then,  by 
order  of  the  senate  of  the  faculty,  stamped  upon  the  breast 
of  the  corpse  the  seal  of  the  university.  The  body  was 
next  carried  into  the  anatomical  hall,  and  the  cover  of  the 
box  in  which  it  had  been  transported  was  returned  to  the 
executioner,  who  remained  at  some  distance  for  this  pur- 
pose. If  the  corpse  was  one  that  had  been  decapitated, 
during  these  solemn  ceremonies  the  head  was  placed  be- 
tween its  legs.  Finally,  an  entertainment  with  music, 
often  furnished  by  itinerant  actors,  was  given.  But  this 
folly  was  gradually  discontinued,  and  by  the  second  half 
of  the  sixteenth  century  public  dissection  was  performed 
without  recourse  to  such  mummeries.  The  price  of  skele- 
tons in  those  days  was  high ;  the  University  of  Heidelberg, 
in  1669,  paid  seventy-two  dollars  for  one. 

The  practitioners  of  the  sixteenth  century  were  often 
quite  as  roving  as  the  students  and  professors,  though 
those  who  held  positions  as  State  physicians  were  bound 
by  contract  to  a  fixed  residence  for  a  certain  time.  In 
1519  the  State  physician  of  Heilbronn  received  a  salary  of 
twenty-one  dollars  per  year  and  his  firewood,  but  could 
not  leave  the  city  over  night  without  permission  of  the 
burgomaster.  Medical  attendants  of  the  King  of  Spain 
were  required  to  kneel  down  when  they  felt  the  king's 
pulse.  There  were  few  physicians  who  acquired  wealth, 
although  Fabricius  ab  Aquapendente  left  a  fortune  of  two 
hundred  thousand  ducats. 

The  Reform  Period  is  the  name  which  llenouard  has 
given  to  the  time  beginning  with  the  commencement  of 
the  seventeenth  century, — a  time  when  the  domain  of 
natural  science  was  daily  enlarged,  and  when  observation 
had  enriched  human  knowledge  with  multitudes  of  new 
facts,  some  of  which  harmonized  with,  and  some  of  which 
were  in  opposition  to,  prevailing  doctrines.     Men  whose 


AMENDMENT   IN    MEDICAL   AFFAIRS.  151 

knowledge  equaled  their  genius  began  to  need  a  radical 
reform,  and  by  such  men  intellectual  improvement  was 
begun  by  which  the  decrepit  theories  of  the  schools  of 
the  Middle  Ages  were  eradicated  and  by  which  there 
were  substituted  for  them  others  which  harmonized  much 
better  with  known  phenomena.  To  the  period  of  worship 
of  ancient  authority  succeeded  one  characterized  by  a 
desire  to  shake  off  the  yoke  of  the  same,  and  men  now 
struggled,  as  it  were,  to  free  themselves  from  the  tyranny 
of  the  past.  As  Galileo  was  the  torch-bearer  for  regen- 
eration of  the  knowledge  of  physics,  and  as  Kepler,  and 
others  already  named,  or  to  be  named,  did  as  much  for 
other  branches  of  science,  so  there  were  not  lacking 
those  who  broke  away  from  the  restraint  of  authority  in 
medicine,  and  began  to  beat  or  choose  paths  for  them- 
selves among  the  facts  which  experimental  science  fur- 
nished them. 

AVith  the  approach  of  the  seventeenth  century  there 
was  evident  improvement  in  both  the  social  and  mental 
status  of  medical  men.  While  political  humiliation  and 
exhaustion  were  everywhere  noted,  in  the  field  of  litera- 
ture it  was  evident  that  the  line  had  advanced.  What 
may  have  been  the  effect  of  thirty  years  of  religious  war, 
with  other  political  struggles  carried  on  under  the  hyp- 
ocritical cloak  of  religion,  may  be  imagined,  if  not  fully 
described;  the  devastation  of  whole  countries  by  disease, 
and  notably  by  the  plague, — the  poverty  and  hunger  con- 
sequent upon  the  ravages  of  perpetual  war  (it  is  stated 
that  even  so  late  as  1792  there  were  still  in  Saxony 
535  wasted  and  extinct  villages),  to  say  nothing  of  the 
barbarity  and  immorality  resulting  therefrom, — all  com- 
bined to  make  the  early  part  of  the  seventeenth  century 
a  most  mournful  epoch.  It  is  not  strange  that,  with 
poverty,  superstition  and  great  rudeness  of  manners  pre- 
vailed, or  that  trials  for  witchcraft  and  persecutions  by\ 
the  Jesuit  Inquisition  were  commojiL  *- That  any  advance 


152  THE   HISTORY   OF   MEDICINE. 

should  have  been  made  under  such  circumstances  speaks 
well  for  the  progress  of  the  human  mind.  That  this 
advance  was  slight  in  Germany  and  central  Europe  is 
not  strange,  though  other  countries  were  able  to  quietly 
enlarge  their  scientific  borders.  Now  it  was  that  England, 
Italy,  and  the  Netherlands,  which  took  but  little  part 
in  the  warlike  struggles  of  the  century,  acquired  leadership 
in  medicine,  and  were  seconded  by  the  French.  In  Great 
Britain,  science  had  been  fostered  by  various  kings,  and 
particularly  by  Charles  II,  who  professed  to  be  something 
of  a  chemist;  in  fact,  an  epidemic  of  scientific  interest 
fell  upon  the  English  court. 

The  seventeenth  century,  in  contrast  to  the  idealistic 
sixteenth,  witnessed  the  advent  of  modern  realism  in  almost 
all  departments  of  thought.  Medicine  furnished  the  first 
example  in  what  we  are  accustomed  to-day  to  speak  of  as 
the  exact  method;  hence,  the  century  is  of  great  impor- 
tance, in  that  physicists  and  chemists  Ijegan  to  be  original, 
instead  of  mere  followers  of  the  past.  .  The  most  notable 
feature  of  medicine  was  the  promulgation  of  three  medical 
systems:  the  pietistically  colored  Paracelsism  of  Van  Hel- 
mont;  the  chemical  system  of  Sylvius;  and  the  iatro- 
chemical  system  of  the  physicist  and  mechanician,  Borelli. 
This  period  is,  moreover,  illumined  by  the  life  of  one  great 
practitioner,  whose  name  will  be  imperishable  in  the  history 
of  our  art, — namely,  Sydenham. 

The  principal  tendency  of  the  time  was  toward  skepti- 
cism, which  had  begun  in  the  preceding  century  with 
Montaigne,  and  was  continued  by  Charron,  under  the 
patronage  of  Queen  ^larguerite  of  Navarre;  it  was  the 
fundamental  idea  of  Pierre  Bayle,  the  author  of  the  great 
dictionary.  Opposed  thereto  was  the  supernatural  philos- 
ophy, or  the  theosophic,  cabalistic,  or  mystic.  The  leading 
exponent  of  the  latter  was  Boehme,  who  was  a  business 
;'  colleague  of  the  celebrated  "  Meistersinger,"  Hans  Sachs, 
?,/f  6  iu  Germany,  and  of  Blftisp  Pascal  and  his  contemporary, 


ADVANCES   IN   OTHER   SCIENCES.  153 

Malebranche,  in  France.  The  doctrine  of  Lord  Bacon, 
Lord  Veriilam  (1561-L626),  a  man  who  showed  him- 
self as  exalted  in  mind  as  he  was  mean  in  personal  traits, 
was  of  great  importance  Bacon  is  a  landmark  in  history 
as  the  defender  and  eulogist  of  modern  realism, — i.e.\  of 
inductive  philosophy.  While  personally  contributing  but 
little  to  the  advance  of  science,  he  taught  a  great  method; 
as  Gruen  says,  he  was  the  philosopher  of  patents  and 
profit;  he  recognized  the  compass,  the  art  of  printing,  and 
gunpowder  as  great  inventions,  but  placed  little  value 
on  the  discovery  of  Copernicus,  having  little  comprehen- 
sion of  mathematics.  Hobbes  and  Locke  went  fartlier 
into  realistic  pliilosophy,  and  the  latter  was  an  exponent 
later  of  pure  empiricism 

In  the  seventeenth  century,  also,  zoology  and  botany 
were  largely  extended.  In  it  lived  Swammerdam  (1637 
-1680),  famous  as  a  naturalist,  physiologist,  linguist, 
poet,  and  savant ;  there  were  others,  also,  whose  names 
are  better  known  in  the  history  of  collateral  science  than 
in  medicine,  and  who  left  conclusive  demonstrations  in 
accordance  with  their  theories,  and  made  daily  use  of 
the  microscope,  simple  as  it  then  was.  The  term  "cell" 
had  been  introduced  by  Hooke  in  1667,  and  Malpighi 
and  Grew  were  the  founders  of  the  cell-doctrine.  The 
astronomical  laws  discovered  by  Copernicus  changed 
the  course  of  the  world's  thought;  and  now  appeared 
the  brilliant  Kepler  (1571-1630),  and  Galileo  (1564- 
1642),  the  defender  of  the  Copernican  system,  and  the 
persecuted  discoverer  of  the  law  of  falling  bodies,  of  the 
thermometer,  the  telescope,  and  the  movements  of  Jupiter; 
also,  Sir  Isaac  Newton  (1642-1727),  whose  discovery  of 
the  laws  of  gravitation  in  1665  marked  an  era  in  the 
history  of  science.  This  century,  too,  gave  birth  to  Romer, 
who  in  1675  calculated  the  velocity  of  hght ;  Huygens 
(1627-1693),  who  discovered  the  polarization  of  light  and 
the    satellites  of  Saturn;    James  Gregory,  who    in    1663 


154:  THE    HISTORY    OF    MEDICINE. 

made  a  reflecting  telescope  with  a  metallic  concave  mirror; 
Torricelli,  wlio  in  1643  measured  tlie  weight  of  the  air; 
Gascoigne,  who  invented  the  micrometer  in  1639;  and 
Napier,  who  invented  logarithms  in   1700. 

Now  chemistry,  having  ceased  to  be  alchemy,  began 
to  don  the  dignity  of  a  science  jper  se,  and  it  may  be 
claimed  that  medicine  derived  no  slight  benefit  therefrom. 
Scientific  societies  and  journals  arose  at  this  period,  and 
were  all  of  good  service  to  medicine  in  their  way.  The 
church  scented  danger  to  the  faith  in  everything  which 
related  to  natural  science,  and  founded  certain  secret 
associations,  especially  in  Italy;  the  Accademia  Degli 
Lincei,  so  called  from  its  seal,  which  bore  the  image  of 
a  fox  or  lynx,  founded  in  Rome  in  1603,  was  one  of 
these.  Counter-societies,  or,  rather,  societies  with  opposite 
purposes,  were  also  started,  and  the  original  and  private 
so-called  Invisible  Society,  which  was  originated  mainly 
by  Milton,  in  1645,  and  remodeled  by  Charles  II  in 
1662,  is  now  the  flourishing  Royal  Society.  In  France 
the  Academy  was  founded  in  1665  by  Colbert,  but  devel- 
oped its  first  real  activity  thirty-five  years  later. 

Those  who  to-day  are  so  familiar  with  the  course  of 
the  circulation  of  the  blood  through  the  arteries  and  veins 
find  it  diflftcult  to  understand  how  the  recognition  of  this 
phenomenon  could  have  been  so  long  delayed ;  it  seems 
so  simple,  yet  to  the  ancients  it  was  perfectly  imcompre- 
hensible !  Although  every  one  had  recognized  that  blood 
Avould  flow  from  an  incision,  few  stopped  to  reason  there- 
upon. From  time  immemorial  it  had  been  supposed  that 
the  veins  had  their  origin  in  the  liver,  and  were  the  only 
vessels  which  contained  blood,  since  the  arteries  were 
always  found  empty  after  death;  the  latter  were  held  to 
contain  only  air  or  spirit.  The  circulation  was  supposed 
to  leave  and  return  to  the  liver  through  the  venous 
canals  by  undulating  movements  similar  to  those  of  the 
waves   of  the   ocean ;    and    this  was    the  doctrine  of  the 


DISCOVERY    OF   THE   BLOOD-CIRCULATION.  155 

Asclepiadae,  and  probably  of  Erasistratus.  Galen  modified 
tills  view  by  showing  that  the  arteries  contained  blood; 
he  knew  it  was  poured  into  the  right  cavities  of  the 
lieart  by  the  great  veins,  but  he  believed  that  only  a 
small  quantity  passed  from  the  right  ventricle  into  the 
lungs,  and  that  the  major  portion  reached  the  left  ventricle 
by  passing  through  pores  in  the  inner  ventricular  septum. 
This  opinion  was  uncontested  until  the  middle  of  the 
sixteenth  century. 

Then  the  theologian,  Michael  Servetus,  who,  in  1553, 
perished  as  the  victim  of  Calvin's  jealousy,  denied  the 
passage  of  the  blood  through  this  septum,  contending  that 
it  was  returned  from  the  lungs  to  the  left  side  of  the  heart 
by  the  pulmonary  veins.  This  was  a  ha])py  thought, 
and  a  great  step  toward  the  truth.  Soon  after  Columbus 
demonstrated  anatomically  that  the  conjecture  of  Servetus 
was  plausible,  by  showing  the  function  and  real  use  of 
the  valves  of  the  heart.  Cesalpinus  came  still  nearer  to 
the  truth,  and  explained,  as  did  Columbus,  the  course  of 
the  circulation  through  the  lungs,  but  he  opined  that  blood 
and  vital  spirits  passed  from  the  arteries  into  the  veins 
during  sleep,  because  at  that  time  there  was  swelling  of 
the  latter  and  diminution  of  the  pulse.  *  Valves  in  the 
veins  were  known,  and  it  had  been  shown  that  ligature 
of  an  artery  in  the  living  animal  stopped  the  flow  below 
it,  while  if  a  vein  were  tied  there  was  shrinkage  above 
the  ligature,  and  swelling  below  it.  Such  was  the  state 
of  science  at  the  beginning  of  the  seventeenth  century  ; 
there  remained,  practically,  but  one  step  to  take, — to  find 
the  true  course  of  the  blood. 

William  Harvey  was  born  in  Folkestone,  Kent,  in 
1578  and  died  in  London  in  1637.  He  first  studied  at 
Cambridge,  entering  at  the  age  of  fifteen;  subsequently 
traveled  in  France,  Germany,  and  Italy,  remaining  in 
Padua  from  1599  to  1602,  in  order  to  hear  the  lectures 
of  Fabricius  ab  Aquapendente.    With  the  title  of  "  Doctor  " 


156  THE   HISTORY    OF   MEDICINE. 

lie  returned  and  settled  in  London  and  soon  became  a 
member  of  the  College  of  Medicine,  of  which  he  was  made 
a  regent  in  1613 ;  in  time  he  became  physician  to  James  I, 
and,  on  the  demise  of  this  sovereign,  to  Charles  I ;  to  the 
latter  he  dedicated  his  chief  work.  During  the  civil  war 
he  was  driven  from  place  to  place,  and,  finally,  to  Oxford, 
where  he  surrendered  himself  to  the  Parliamentary  troops, 
after  which  he  again  resided  in  London  with  his  brothers. 


Fig.  22.— William  Harvey,  M.D. 

(From  a  wood-engraving  of  a  painting  b_v  Benimel.) 

who  had  become  rich.  Modesty  led  him  to  decline  the 
high  distinction  of  President  of  the  College  of  Physicians, 
and  he  lived  a  quiet  and  retired  life,  occupied  with  his 
studies  and,  in  his  later  years,  investigations  in  mathematics. 
Soon  after  1613  he  began,  through  liis  lectures,  to  make 
known  the  doctrine  of  the  circulation  of  the  blood ;  but  he 
did  not  publish  the  results  of  his  researches  until  1628, 
after  submitting  them  to  fifteen  years  of  proofs  and  counter- 


WILLIAM    HARYET.  157 

proofs  of  every  kind.  So  bitter  was  the  opposition  of  his 
contemix)raries  to  the  new  doctrine  that  he  at  one  time  lost 
a  part  of  his  practice,  and  was  even  held  to  be  demented. 
It  is  characteristic  of  the  fat«  of  new  truths,  as  well  as  of 
that  age  of  dominant  authority,  that  his  tirst  publication — 
Concerning  the  Motions  of  the  HeaH  and  the  Blood — was 
unable  to  pass  censorship  in  England,  and  therefore  ap- 
peared in  a  foreign  country  (Frankfort,  in  1628)  when  he 
was  fifty  years  old ;  but  his  second  treatise  on  the  same 
subject,  in  reply  to  Riolan,  a  professor  in  the  Faculty  of 
Paris,  was  published  in  Cambridge  in  1649. 

"  So  much  care  and  circumspection  in  search  for  truth, 
so  much  modesty  and  firmness  in  its  demonstration,  so  much 
clearness  and  method  in  the  development  of  his  ideas,"  says 
Renouard,  "  should  have  prepossessed  every  one  in  favor 
of  the  theory  of  Harvey ;  but,  on  the  contrary,  it  caused  a 
general  stupefaction  in  the  medical  world,  and  gave  rise  to 
great  opposition." 

This  theory,  which  to-day  appears  so  natural  that  we 
conceive  with  difficulty  why  it  was  not  sooner  discovered, 
was  nothing  less  than  a  revolution  in  physiology ;  it 
excited  a  tremendous  controversy  that  continued  more 
than  twenty-five  years,  and  in  which  mingled  every  one 
possessed  of  any  pretension  to  knowledge  of  anatomy  or 
physiology ;  even  naturalists  and  philosophers  took  part  in 
the  dispute.  Rene  Descartes  was  the  first  to  declare  in  its 
favor  and  to  support  it  by  exjieriment;  John  Walaeus 
(Jan  de  Wale),  the  celebrated  Professor  of  Anatomy  in  the 
University  of  Leyden,  confirmed  it  by  new  observations : 
finally  Plempius,  of  Louvain,  for  a  time  one  of  the  most 
fiery  of  opponents,  succumbed  to  the  truth,  and  in  1652 
passed  publicly  to  the  ranks  of  Harvey's  followers — ^no 
small  triumph ! 

Durins:  these  lon^  debates  Harvev  remained  alwavs 
dignified  and  firm,  although  the  early  attacks  rendered  him 
unduly  sensitive  regarding  others  which  he   anticipated. 


158  THE    HISTORY    OF    MEDICINE. 

About  his  only  answer  to  the  arguments  adduced  agamst 
him,  was  to  add  new  proofs  and  new  experiments  to  those 
already  published.  The  only  one  of  his  adversaries  who 
obtained  a  direct  response  was  Riolan,  who  possessed  im- 
mense influence  amont(  his  contemporaries  as  a  man  of 
attainments ;  Riolan  combated  with  equal  violence  and  ob- 
stinacy the  other  great  discovery  of  the  age, — viz.,  the  cir- 
culation of  the  lymph.  Harvey  ultimately,  however,  had 
the  satisfaction  of  seeing  his  theory  universally  adopted. 
But  his  services  were  not  limited  to  this  one  discovery. 
He  made  most  interesting  observations  on  generation,  both 
in  man  and  in  animals  ;  on  midwifery  ;  and  on  the  structure 
and  diseases  of  the  uterus. 

The  intermediary  system  and  bond  of  union  between 
the  arteries  and  veins,  so  very  essential,  yet  up  to  this  time 
unknown,  was  discovered  by  the  great  Malpighi,  who  was 
born  in  1628  near  Bologna,  became  professor  in  its  univer- 
sity, and  discovered  in  the  lungs  and  mesentery  of  frogs,  in 
1661,  the  capillary  circulation.  He  first  described  the  cor- 
puscles of  the  blood  in  1665;  he  also  discovered  the  lung- 
cells,  as  well  as  the  cutaneous  glands,  certain  portions  of 
the  kidney,  and  the  pigmentary  layer  of  the  skin,  named 
after  him  {rete  Malpighi)^  which  later  furnished  the  first 
explanation  of  the  difterence  of  color  in  different  races. 

In  1690  Leeuwenhoek  (1632-1728),  who  had  been 
making  observations  on  the  larvae  of  frogs  and  other  small 
animals,  was  able  to  see  with  his  improved  microscope  the 
movements  of  the  blood  in  the  small  vessels,  and  gave  the 
important  testimony  of  his  observations.  In  1687  Cowper 
saw  the  passage  of  the  arterial  into  the  venous  current 
in  the  mesentery  of  a  cat.  The  capillary  connection  be- 
tween the  two  vascular  systems  was  first  demonstrated  by 
Marchetti,  but  was  best  shown  by  Ruysch  (1638-1731), 
professor  at  Amsterdam,  the  famous  inventor  of  minute 
injections,  who  greatly  advanced  anatomy  by  the  forma- 
tion of  collections,  one  of  which  was  brought  into  Russia 


\>T^ 


rs 


INFLUENCE   OF    HARVEY's   DISCOVERY.  159 

by  Peter  the  Great  at  an  expense  of  about  seventy-five 
thousand  dolhirs.  The  Russian  transporters  of  the  collec- 
tion, liowever,  drank  tlie  alcohol  in  which  many  of  the 
preparations  were  preserved,  and  a  portion  of  the  specimens 
was  tlius  ruined. 

Further  illustration  and  amplification  of  Harvey's  views 
came  from  various  sources;  the  last,  perhaps,  from  Nich- 
olaus  Steno  (1638-1686),  who  was  first  a  professor  in 
Copenhagen,  then  a  bishop  and  peripatetic  converter  of 
heretics.  Steno  first  proved  the  heart  to  be  a  muscle  that 
contracts  actively  and  expels  the  blood.  The  duct  that 
bears  his  name  was  discovered  during  his  residence  in 
Leyden  or  at  Amsterdam.  His  name  is  written  also 
"  Stenson." 

Wliile  ancient  anatomists  were  able  to  describe  in  a 
general  way  the  form  of  the  lungs,  their  location,  consist- 
ency, the  ring-like  structure  of  the  trachea,  and  the  first 
division  of  the  bronchi,  they  did  not  go  farther,  but  blindly 
accepted  the  ])revalent  theory  that  the  bronchial  tubes 
anastomosed  with  the  terminal  pulmonary  veins,  and  that 
in  this  way  atmospheric  fluid  was  conveyed  from  the  respi- 
ratory organs  into  the  heart.  On  such  vague  and  erroneous 
data  was  constructed  the  theory  that  the  air  was  drawn  into 
the  lungs  by  the  heat  of  the  heart,  which  was  the  reservoir 
of  the  vital  spirits ;  that  in  penetrating  through  the  smaller 
tubes  it  was  rarefied,  its  thinnest  part  passing  into  the  heart, 
where  it  served  as  material  for  the  formation  of  the  vital 
spirit,  its  grosser  part  being  exhaled.  In  other  words,  res- 
piration was  supposed  to  have  two  purposes .  one  to  refresh 
the  lungs,  which,  being  porous  and  inflammable,  would 
otlierwise  take  fire  from  the  heart,  or  focus  of  animal  heat; 
the  other  to  furnish  the  pneuma,  or  ether,  which  was  em- 
ployed by  the  heart  in  the  formation  of  animal  spirits. 
Harvey's  discovery  upset  all  this,  in  great  measure. 

Next  it  was  shown  that  pulmonary  veins  carried  noth- 
ing to  the  heart  except  blood.     And  now,  during  this  Re- 


/^eu^^^  j/ir  2C>-rw 


160  THE   HISTORY    OF   MEDICINE. 

form  Period,  the  purpose  of  the  movements  of  the  chest 
was  better  studied,  for  Borelli,  Helvetius,  and  Haller  made 
many  experiments,  as  the  result  of  wliich  it  was  determined 
tliat  during  inspiration  the  thorax  is  enlarged  in  all  direc- 
tions, and  during  expiration  partly  collapsed  by  relaxation 
of  muscles,  and  that  there  never  is  any  empty  space  be- 
tween the  lungs  and  the  sides  of  the  chest ;  further,  that 
air  is  drawn  into  the  chest  by  the  tendency  of  all  gases  or 
fluids  to  maintain  an  equilibrium,  or,  in  otlier  words,  be- 
cause Nature  abhors  a  vacuum.  This  being  settled,  various 
pneumatic  theories  were  adopted  and  abandoned,  all  of 
which  had  subsequently  to  give  way  before  a  knowledge  of 
what  really  occurs.  The  truth  was  conceived  of  by  Mayow 
in  1668.  It  had  been  noticed  that  blood  which  appeared 
black  in  issuing  from  the  veins,  became  red  in  contact  with 
the  air,  and  direct  observation  proved  a  similar  change  of 
color  to  take  place  during  its  passage  from  the  pulmonary 
veins  during  life.  Goodwin,  opening  the  thorax  of  a  frog, 
was  the  first  to  see  this,  and  Hessenfratz  filled  a  silk  bladder 
with  venous  blood,  and,  plunging  it  into  an  atmosphere  of 
oxygen,  saw  the  blood  change  from  black  to  red.  In  this 
way  and  by  the  later  labors  of  Bichat  and  I^voisier  were 
clearly  established  the  mechanism  and  the  purpose  of  the 
function  of  respiration. 

The  discovery  of  the  lymphatic  vessels  and  their  pur- 
pose was  scarcely  less  remarkable  than  that  of  the  circu- 
lation, though  marked  by  less  eclat  because  it  was  not  the 
work  of  one  man,  but  a  matter  of  slow  development.  He- 
rophilus  and  Erasistiatus  had  seen  wliite  vessels  connected 
with  the  lymph-nodes  in  the  mesentery  of  animals,  and  sup- 
posed them  to  be  arteries  full  of  air.  Galen  disputed  this, 
for  he  believed  that  the  intestinal  chyle  was  carried  by  the 
veins  of  the  mesentery  into  the  liver.  In  156»3  Eustachius 
described  the  thoracic  duct  in  the  horse.  In  1622  Aselli, 
Professor  of  Anatomy  at  Milan,  discovered  the  lacteal  ves- 
sels in  a  dog  which  had   been  killed  immediately  after 


DISCOVERY    OF   THE    LYMPH-CIRCULATION.  161 

partaking  of  food ;  having  pricked  one  of  these  by  mis- 
take, he  saw  a  white  fluid  issue  from  it.  Repeating  the  ex- 
periment, lie  became  certain  that  the  white  threads  were 
vessels  which  drew  the  chyle  from  the  intestines.  He 
observed  the  valves  with  which  they  are  supplied,  and  sup- 
posed these  vessels  all  met  in  the  pancreas  and  continued  on 
into  the  liver.  In  1647  Pecquet,  while  still  a  student  at 
Montpellier,  discovered  the  lymph-reservoir,  or  receptaculum 
chyll^  and  the  canal  which  leads  from  it  (the  thoracic  duct), 
which  he  followed  to  its  termination  in  the  left  subclavian 
vein.  Having  ligated  the  duct,  he  saw  it  swell  below  and 
become  empty  above  the  ligature.  He  studied  the  courses 
of  the  lacteals,  and  convinced  himself  that  they  all  entered 
into  the  common  reservoir.  This  discovery  gave  the  last 
blow  to  the  ancient  theory  which  attributed  to  the  liver  the 
function  of  blood-making,  and  confirmed  the  doctrine  of 
Harvey.  Strangely  enough,  the  latter  united  with  Riolaii 
in  opposing  the  discovery  of  Pecquet  and  denying  its  sig- 
nificance. From  this  time  the  lymphatic  vessels  and 
glands  became  objects  of  common  interest  and  were  inves- 
tigated by  many  anatomists, — by  Bartholin,  Ruysch,  the 
Hunters,  Hewson,  and,  above  all,  by  Mascagni,  who  was 
the  first  to  give  a  graphic  description  of  the  whole  lym- 
phatic apparatus. 

The  ancients  confounded,  under  the  name  "neuron," 
nerves,  tendons,  ligaments,  and  membranes ;  even  Aristotle 
regarded  the  brain  as  an  inert  mass  devoid  of  sensation, 
and  supposed  the  nerves  to  originate  in  the  heart.  Rufus, 
of  Ephesus,  remarked  that  Herophilus  distinguished  three 
sorts  of  nerves, — the  first  serving  for  sensation  and  motion 
and  proceeding  from  the  brain  and  spinal  marrow,  the 
second  and  third  serving  to  unite  bones  and  muscles. 
Galen  also  shared  in  this  error,  but,  nevertheless,  described 
the  brain-membranes  and  the  difference  between  white  and 
gray  matter ;  he  supposed  the  cerebrum  to  be  the  seat  of 

the  soul  and  origin  of  sensory  nerves,  and  that  the  cere- 

n 


162  THE    HISTORY    OF    MEDICINE. 

bellum  gave  rise  to  nerves  of  motion  ;  the  pulsation  of  the 
cerebrum  exposed  was  held  to  be  a  sort  of  brain  respira- 
tion. Galen  came  very  near  recognizing  the  distinction 
between  nerves  and  tendons,  but  nevertheless  confused 
them.  The  anatomists  of  tlie  sixteenth  century  described 
certain  portions  of  the  nervous  system  with  more  exact- 
ness than  did  Galen,  but  not  with  sucli  positiveness  as  to 
prevent  Cesalpinus  from  renewing  the  Aristotelian  theory 
that  the  heart  was  the  origin  of  sensation  and  the  seat  of 
the  soul.  Nearly  two  centuries  later  Baglivi  advanced  a 
theory  which  referred  vital  movement  to  the  heart  and  the 
dura  mater. 

The  progress  which  accrued  to  comparative  anatomy 
and  physiology,  and  the  experiments  which  were  made  on 
animals,  during  this  period,  shed  a  great  deal  of  light 
upon  the  nervous  system.  The  researches  of  Vieussens, 
Haller,  Meckel,  Vicq  d'Azyr,  Scarpa,  Soemmering,  and 
others  had  already  rendered  it  manifest  that  the  brain  was 
the  organ  of  sensation  and  voluntary  motion,  and  Bichat 
had  proposed  to  divide  the  nervous  system  into  cerebro- 
spinal and  sympathetic  branches. 

Now,  too,  Kepler  discovered  that  the  crystalline  lens 
was  not  the  seat  of  vision,  as  had  been  supposed,  but  that 
its  function,  like  that  of  other  lenses,  is  the  refraction  of 
light.  He  observed  that  the  image  of  objects  is  depicted 
upon  the  retina,  and  (with  Scheiner)  demonstrated  that  the 
expansion  of  the  optic  nerve  in  the  retina  is  the  essential 
part  in  the  organ  of  sight.  Obviously,  also,  interest  in 
the  anatomy  of  the  eye,  which  these  observations  every- 
where stimulated,  was,  in  a  great  measure,  aided  by  the 
researches  of  Newton  on  light  and  color. 

About  this  time,  too,  Casserius  and  others  studied  the 
auditory  apparatus  and  described  the  ossicles,  the  small 
muscles  of  the  internal  ear,  and  the  semicircular  canals ; 
they  even  followed  the  acoustic  nerve.  By  the  researches 
of  a  number  of  French  and  Italian  anatomists  it  was  like- 


DISCOVERY    OF    THE    IRRITABILITY    OF    TISSUE,  1G3 

wise  established  that  tlie  true  seat  of  hearing  lies  withiti 
the  internal  ear,  the  external  parts  being  merely  of  assist- 
ance in  conducting  sound. 

Thomas  Willis  was  one  of  the  first  to  consider  the 
brain  as  an  assemblage  of  organs  and  to  assign  special 
functions  to  certain  of  its  divisions;  he  thus  became  a 
pioneer  in  cerebral  localization,  although  most  of  his  con- 
jectures were  inaccurate  or  fanciful.  The  workings  of 
the  brain  were  also  studied  by  Pinel  and  others,  who  ob- 
served that  in  certain  conditions  of  mania  or  partial 
insanity  some  of  tlie  mental  faculties — such  as  memory, 
judgment,  imagination,  or  will — were  abolished  or  sus- 
pended, while  other  faculties  were  preserved  ;  hence  it  was 
inferred  that  each  faculty  must  have  its  own  seat.  The 
views  thus  enunciated  were  carried  to  an  absurd  degree  by 
Gall,  an^^  later  by  S[)urzheim,  who  made  an  entirely  new 
classification,  believing  the  cranium  to  be  molded  in  a 
reasonably  exact  manner  upon  the  brain,  and  that,  by 
inspection  of  the  exterior,  the  character  of  a  given  indi- 
vidual could  be  read.  They  thus  founded  the  pseudo- 
science  denominated  phrenology,  which  we  now  know  has 
practically  nothing  to  justify  itself. 

About  the  middle  of  the  seventeenth  century  Glisson 
(a  professor  in  the  University  of  Oxford)  recognized  a  prop- 
erty pertaining  to  all  living  tissue,  which  he  termed  irrita- 
bility, and  which  he  regarded  as  sufficient  cause  for  all  the 
phenomena  of  life ;  he  enunciated  certain  views  that,  in 
times  past,  have  liad  an  important  bearing  upon  the  pa- 
thology of  disease,  but  whicli  were  forgotten  for  sixty  years 
or  more  until  revam[)ed  by  the  Dutch  anatomist,  Goerter. 
It  was  the  latter,  with  the  great  Haller,  who,  by  a  series 
of  very  ingenious  experiments,  elevated  the  suppositions  of 
Glisson  to  the  dignity  of  demonstrated  facts.  In  1747  the 
results  of  Haller's  researches  were  published  under  the 
modest  title  of  First  Lines  in  Physiology ;  the  author 
was,  in  fact,  the  great  exponent  of  the  doctrine  of  irrita- 


164  THE   HISTORY   OF   MEDICINE. 

bility  in  neurophysiology,  and  for  this  deserves  to  be 
remembered  wherever  the  history  of  our  art  is  spoken  of. 
This  theory  of  irritability  was  applied  to  pathology  by 
Fabre,  of  Paris,  who  refuted  the  mechanical  theory  of 
Boerhaave  on  inflammation,  proving  that  the  latter  pro- 
ceeds not  from  obstruction  of  the  cai)illaries,  but  from 
exaltjition  of  their  irritability.  It  was  also  applied  in 
many  ways  by  Bichat,  who  enjoyed  a  brief,  though  mem- 
orable, career.  The  theory  of  irritability,  along  with  the 
truths  established  by  John  Hunter  in  his  researches  on  the 
blood,  made  a  very  distinct  advance  in  the  physiological 
knowledge  of  the  seventeenth  century,  and  the  researches 
of  those  who  contributed  so  much  to  its  advance  are  well 
worthy  of  study  even  at  the  present  day.  In  this  line  of 
investigation  should,  perhaps,  also  be  mentioned  the  names 
of  Winslow,  Albinus,  the  two  Monroes,  besides  Vicq 
d'Azyr,  and  others  already  named. 

I  have  so  far  discussed  the  development  of  theories  and 
researches  of  individuals.  During  the  earlier  portion  of 
the  seventeenth  century  there  happened  something  which 
gave  to  materia  medica  a  remedy  so  valuable,  and  which 
attracted  such  wide-spread  attention,  that  it  deserves  special 
mention.  I  refer  to  the  discovery  of  that  great  febrifuge, 
Peruvian  bark.  Malarial  fevers  liad  been  known  as  early 
as  the  time  of  Hippocrates,  and  were  universally  treated 
largely  with  purgatives,  sometimes  with  venesections. 
There  had  been  no  notable  improvement  in  the  manage- 
ment of  pyrexias  of  this  class  down  to  1638,  when  the 
Countess  of  Cinchon,  wife  of  the  Viceroy  of  Peru,  became 
a  prey  to  a  fever  which  nothing  could  remove.  It  is  said 
a  Spaniard  learned  from  the  natives  the  secret  of  the  bark, 
and  advised  its  employment,  whereby  the  countess  recov- 
ered her  health.  This  is  the  generally  received  account, 
although  it  has  been  widely  discredited,  and  Humboldt 
expresses  decided  doubts  as  to  the  source  whence  the  first 
knowledge  of  the  bark  was  derived.     Be  this  as  it  may. 


INTRODUCTION    OF    PERUVIAN    BARK.  165 

however,  it  is  certain  that,  in  1639,  the  countess  and  her 
physician,  de  Vega,  imported  into  Spain  a  quantity  of 
ground  Peruvian  bark,  and  distributed  it  to  various 
persons,  tliough  it  was  not  made  an  article  of  general 
commerce  until  ten  years  later,  when  it  was  exploited  by 
the  Jesuits,  who  had  received  a  large  supply ;  in  Spain  it 
was  known  as  the  "  countess's  powder,"  and  in  Italy  as 
"  Jesuit "  or  "  cardinal  "  powder.  Being  very  high-priced, 
it  was  soon  so  sophisticated  as  to  be  quite  unreliable.  Con- 
damine,  the  botanist,  having  been  sent  to  America  for 
other  purposes,  determined  the  botanical  position  of  the 
tree  and  described  several  species  of  cinchona,  one  of 
which  is  known  by  his  name.  To  him  is  due  the  generic 
title  bestowed  in  acknowledgment  of  the  services  rendered 
by  the  countess,  who  introduced  the  bark  into  Europe. 
Many  vain  attempts  were  made  to  determine  the  chemical 
composition  of  the  powder,  and  it  remained  for  two  French 
chemists  to  isolate  and  separate  its  most  important  alkaloid. 
The  first  who  wrote  upon  the  therapy  of  cinchona  was 
Barba,  a  Spanisli  physician,  whose  work  was  printed  in 
Seville  hi  1642.  After  its  introduction  into  England 
Peruvian  bark  fell  into  disrepute,  owing  to  improper 
admhiistration,  whereby  death  was  caused  in  certain 
instances;  and  it  was  this  latter  fact  that  instigated 
Sydenham  to  investigate  it  still  more  accurately.  There 
has  never  been  introduced  into  medicine  any  one  drug 
which  has  proved  itself  so  generally  valuable  and  so  widely 
effective  as  chichona  and  its  products. 

As  little  progress  bad  been  made  in  obstetrics  as  in 
other  branches  of  applied  medicine  or  surgery.  The  custom 
of  employing  midwives  was  general,  and  these,  for  the  most 
part,  were  ignorant  and  filthy  old  women,  slaves  of  routine 
procedures  that  had  obtained  from  time  immemorial. 
Educated  accoucheurs  were  called  only  in  extraordinary 
cases ;  but  with  progress  the  prejudice  which  excluded 
educated  physicians  from  the  practice  of  midwifery  gradu- 


166  THE    HISTORY    OF    MEDICINE. 

ally  gave  way,  and  there  was  opened  for  obstetrics  a  new 
era.  In  the  beginning  of  the  seventeenth  century  the  in- 
itiative was  taken  by  Louise  Bourgeois,  the  sage  femme  of 
Marie  de  Medicis,  wlio  in  1626  published  a  collection  of 
observations  concerning  sterility,  abortion,  fecundity,  ac- 
couchement, and  diseases  of  women  and  children  generally; 
it  embodied  several  distinctly  new  ideas.  A  little  later  (in 
1668),  Mauriceau,  of  Paris,  chief  accoucheur  to  the  Hotel- 
Dieu,  published  his  treatise  on  diseases  of  pregnancy  and 
childbirth,  which  was  translated  into  all  the  languages  of 
Europe  and  became  a  powerful  agent  for  good,  not  alone 
that  it  represented  an  advance  in  knowledge,  but  it  stimu- 
lated such  rivals  and  successors  as  Deventer,  Pen,  Paul 
Portal,  and  Delamotte  to  further  research.  About  this 
time  the  Chamberlains,  an  English  family  devoted  to  the 
practice  of  midwifery,  invented  an  instrument  to  facilitate 
the  extraction  of  the  fcetal  head  when  arrested,  and  one  of 
them  went  to  Paris,  and,  failing  of  success  there,  went  on 
to  Holland,  where  he  sold  his  secret  to  two  Dutch  prac- 
titioners, who  kept  it  only  too  faithfully.  In  1721,  Palfyn, 
a  surgeon  of  Ghent,  while  seeking  to  fathom  the  device  of 
the  Chamberlains,  conceived  a  tire-tete  (literally  a  head- 
drawer)  composed  of  two  steel  spoons,  and  hastened  to 
publish  an  account  thereof, — a  praiseworthy  act,  whereby 
he  merits  distinction  as  the  inventor  of  the  forceps.  As 
modified  by  Smellie  in  England  and  Levret  in  France,  the 
obstetrical  forceps  ranks  among  the  most  useful  discoveries 
of  modern  surgery,  and,  although  not  in  common  use  until 
about  a  centurv  a<>o,  it  mav  be  said  that  the  invention  has 
been  the  means  of  saving  the  lives  of  countless  women  and 
children. 

Medical  jurisprudence  also  seems  to  have  had  its 
beghming  during  this  century.  It  had  long  been  the 
practice  to  summon  physicians  to  court  in  order  to  en- 
lighten the  judiciary  in  questions  demanding  particular 
knowledge  in  physics  and  medicine ;  indeed,  the  practice 


EARLIEST    SYSTEMATIC   CLINICAL   TEACHING.  167 

began  under  tlie  first  Christian  emperors,  and  owes  its 
origin  to  ecclesiastical  autliorit}'.  Charlemagne  confirmed 
in  this  regard  what  Justinian  was  perhaps  the  first  to 
ordain.  The  tribunal  of  Chatelet,  according  to  Renouard, 
appears  to  have  been  the  first  which  comprehended  the 
great  utility  of  consultation  with  expert  physicians ;  an 
edict  of  Philip  le  Bel,  in  1311,  qualified  Master  John 
Potard  with  the  title  "  Sworn  Surgeon  of  Chatelet ";  and 
tlie  constitution  promulgated  by  Charles  V,  in  1552,  gave 
great  importance  to  medical  jurisprudence,  as  it  treated  in 
detail  of  infanticide,  wounds,  poisons,  abortion,  and  other 
such  crimes.  Early  in  the  seventeenth  century  Fidelis 
collated  all  that  had  been  written  on  this  subject,  and  thus 
published  the  first  special  treatise  on  legal  medicine. 

Some  writers  claim  to  have  discovered  traces  of  clinical 
teaching  in  the  history  of  Arabian  universities,  but,  as 
Renouard  says,  the  presence  of  a  few  pupils  during  visi- 
tations and  consultations  no  more  constituted  real  clinical 
teaching  than  the  practice  adopted  by  some  practitioners 
of  ancient  Rome  of  being  ever  surrounded  by  a  group  of 
spectators  whom  they  dignified  with  the  title  of  disciples. 
The  first  attempt  at  real  clinical  teaching  appears  to  have 
been  in  the  hospital  of  St.  Francis,  in  Padua,  in  1558,  by 
Botoni  and  Oddi,  i\bout  the  beginning  of  the  seventeenth 
century  Otto  de  Heurne,  of  the  University  of  Leyden,  in- 
troduced bedside  instruction,  which  was  continued  by  le 
Boe,  sometimes  called  Sylvius,  with  the  result  of  drawing 
large  crowds  of  students  to  Leyden  from  1658  to  1672. 
Notwitlistanding  the  success  attained,  the  practice  was 
neglected  by  the  successors  of  Sylvius  until  renewed  by 
Boerhaave,  who,  invested  with  several  functions  at  the  Uni- 
versity of  Leyden,  also  occupied  the  chair  of  medicine.  So 
great  was  the  renown  of  Boerhaave  that,  despite  the  poverty 
of  the  resources  of  the  Leyden  hospital,  people  came  to 
consult  him  from  the  most  distant  countries,  and  he  was  a 
correspondent  of  several  crowned  heads,  even  of  the  Pope, 


168  THE   HISTORY   OF   MEDICINE. 

although  himself  a  Protestant.  During  his  life  and  long 
afterward  he  exerted  an  immense  influence  in  medicine,  and 
while,  perhaps,  inferior  in  genius  to  some  of  his  contem- 
poraries, he  had  a  wider  reputation,  and  his  doctrines  pre- 
vailed longer.  Tlie  great  success  of  his  clinics  decided  in 
favor  of  this  method  of  teaching,  and  in  1715  the  Pope 
established  in  Rome  a  similar  institution,  under  the  direc- 
tion of  the  celebrated  Lancisi.  Soon  Edinburgh,  Vienna, 
Pavia,  and  other  universities  followed  suit,  the  first  clinical 
chair  in  Paris  being  held  by  Corvisart,  and  the  first  in 
Vienna  by  Van  Swieten.  After  the  demise  of  Boerhaave, 
the  school  of  Leyden  rapidly  declined,  while  those  of  Edin- 
burgh and  Vienna  became  rivals  for  the  first  place.  It  is 
thus  seen  that  after  an  interruption  of  more  than  two  thou- 
sand years  clinical  teaching  was  revived  and  became  more 
brilliant  than  ever  before. 

I  now  propose  to  recount  the  methods  and  deeds  of 
some  of  those  concerned  in  the  development  of  systems,  so 
called,  and  make  mention  of  the  most  prominent  medical 
men  in  national  and  historical  order.  This  will  not  prevent 
going  back  to  philosophical  conclusions  or  reflections  upon 
the  philosophy  of  the  history  of  medicine,  when  it  may 
seem  wise  so  to  digress. 

First,  of  the  system  of  J.  B.  Van  Helmont,  which  in  its 
day  was  most  highly  regarded,  and  which  seems  to  have 
been,  in  some  measure,  a  rearrangement  of  tlie  views  of 
Paracelsus  into  a  mystic  and  pietistic  system  based  upon 
mechanical  principles.  Van  Helmont  was  born  in  Brussels 
in  1578,  and  was  so  precocious  that  he  entered  the  Uni- 
versity of  Louvain  at  an  age  which  would  have  enabled 
him,  had  he  so  desired,  to  obtain  the  degree  of  Magister 
when  only  seventeen  years  old.  He  deemed  the  degree 
frivolous.  He  had  studied  mathematics,  astronomy,  phil- 
osophy, and  astrology.  Going  now  to  the  Jesuits,  wlio  at 
that  time,  even,  taught  music,  he  soon  became  dissatisfied, 
and  turned  to  the  study  of  stoical  philosophy.     Believing 


VAN    HELMONT.  169 

that  the  Capuchins  (who  were  mere  lascivious  gluttons, 
and  considered  even  washing  unchristian)  were  the  true 
stoics,  he  sought  to  join  this  order,  but  ere  long  abandoned 
them  and  resumed  his  studies  in  law,  botany,  and  medi- 
cine. For  the  latter  Van  Helmont  had  at  first  little  respect, 
since  his  studies  in  this  line  did  not  enable  him  to  rid  him- 
self of  the  itch.  He  soon  again  lapsed  to  the  monastics, 
and  came  to  the  conclusion  that  wisdom,  like  the  grace  of 
God,  was  obtainable  only  by  fasting,  supplication,  and 
poverty ;  accordingly  he  practiced  medicine  among  the 
poor  as  a  labor  of  love  (having  received  his  degree  of 
Doctor  in  1599).  During  his  travels  he  became  familiar 
with  the  writings  of  Paracelsus,  which  he  studied  zealously. 
Finally  he  settled  down  in  Vilvorde,  where  he  practiced 
medicine  and  cjiemistry  until  his  death  (in  1644). 

Like  most  "  systems,"  that  of  Van  Helmont  is  valued 
only  as  an  expression  of  the  spirit  of  the  age,  since  it  em- 
bodied largely  the  pantheism  of  Paracelsus,  merely  cloaked 
with  a  more  religious  or  monkish  dress.  He  held  that  the 
general  cause  of  disease  was  the  fall  of  man  ;  though  there 
also  figured  a  subsidiary  cause,  which  he  denominated 
Archeus, — a  faculty  of  appetite  seated  in  the  spleen  or  in 
the  stomach ;  thus  dropsy  was  a  hindrance  of  renal  ex- 
cretion by  the  enraged  Archeus.  Demons,  witches,  and 
ghosts  were  included  in  Van  Helmont's  system  as  causes 
of  disease.  Indeed,  the  man  seems  to  have  been  a  second 
Paracelsus,  lacking  only  in  the  dishonesty  and  bombast  of 
the  latter.  He  had  no  followers  of  any  prominence,  and 
the  "  system  "  soon  lapsed  into  obscurity. 

The  Chemical,  or  latrochemical,  System  was  originated 
by  le  Boe,  commonly  known  as  Sylvius  (but  who  must 
not  be  confounded  with  the  great  anatomist  of  the  same 
name).  Le  Boe  was  born  in  Hanau  in  1614;  studied  in 
Paris,  Leyden,  and  Basel ;  received  his  doctorate  from 
the  latter  university  at  the  age  of  twenty,  and  practiced 
in    Switzerland  with  great    success   until  1660,  when  he 


170  THE    HISTORY    OF    MEDICINE. 

accepted  a  professorship  in  Leydeii ;  here  he  was  distin- 
guished for  his  eloquence,  wealth,  and  sociability,  as  well 
as  for  the  great  number  of  pupils  that  were  attracted  by 
his  clinical  method  of  teaching.  His  system  embraced  a 
peculiar  phantasy,  being  based  upon  the  elements  of  chem- 
istry, the  new  knowledge  of  the  circulation,  the  latest 
physiological  teachings,  and  the  old  doctrine  of  the  spirit- 
uous or  innate  heat  of  the  heart,  which  he  claimed  to  have 
felt  with  his  finger.  He  asserted  his  theories  were  foinided 
upon  experience,  but  the  truth  is,  they  were  inaccurate 
deductions  from  experimental  observations,  many  of  which 
were  wholly  irrelevant.  The  majority  of  diseases,  he 
taught,  were  produced  by  excess  of  acidity  or  alkalinity. 
For  him,  the  three  great  fluids  of  the  body  were  the  saliva, 
the  pancreatic  fluid,  and  the  bile,  while  health  consisted  in 
the  undisturbed  performance,  in  the  body  of  the  process  of 
fermentation ;  and  the  saliva  was  supposed  to  give  rise  to 
hectic  fevers,  because  such  manifest  exacerbation  after 
eating.  Stereotyped  theory  and  equally  stereotyped  thera- 
peutics gained  for  him,  for  a  short  time,  a  large  following, 
but  later  raised  numerous  oi)ponents,  who  alleged  that  his 
system  cost  as  many  human  lives  as  the  whole  thirty  years* 
war.     He  died  in  1672. 

To  the  same  iatrochemical  school  is  generally  assigned 
Thomas  Willis,  born  in  Oxford  in  1622  (died  in  1675),  who 
rendered  great  service  to  anatomy,  especially  to  anatomy 
of  the  nervous  system,  although  his  teaching  was  disfigured 
by  certain  unsupported  theories.  Like  Van  Helmont,  he 
had  been  destined  for  theology,  but  turned  his  attention  to 
medicine.  Ultimately  he  became  Professor  of  Pliilosophy 
in  the  University  of  Oxford.  He  first  described  the  so- 
called  circle  of  Willis,  whence  its  name ;  also  ascribed  dis- 
eases, especially  those  of  the  blood,  to  fermentation,  in 
which  the  vital  spirits  played  the  chief  part.  He  accounted 
for  hysteria,  for  instance,  by  the  union  of  the  spiritus  with 
imperfectly  purified  blood. 


CHAPTER  VII. 

Age  of  RexovatiojJ  {continued). — latromechanical  School:  Santoro,  1561- 
1635.  Borelli,  1608-1679.  Sydenham,  1624-1689.  Sir  Thomas  Browue, 
imo-WS-I.—Suiyery :  Denis,  1 1704.  F.  Collot,  1 1706.  Dionis,  fl^lS. 
Baulot  (Frere  Jacques),  1671-1714.  Scultetus,  1595-1645.  Ran,  f  1719. 
Wiseman,  1625-1686.  Cowper,  1666-1709.  Sii-  C.  Wren  the  Discoverer 
of  Hypodermatic  Medication.  Anatomical  Discoveries.  General  Con- 
dition of  the  Profession  during  the  Seventeenth  Century.  The  Eighteenth 
Century.  Boerhaa\e,  1668-1738.  Gaub,  1705-1780.— ^« /»»«»* :  Stahl, 
1660-n3i.—JIechanico-dynamic  Syniem :  Hoffmann,  1660-1742.  Cullen, 
1712-1790.— OW  Vienna  School:  Van  Swieten,  1700-1772.  De  Haen, 
1704-1776.— r//a//.sHt.-  Borden,  1732-1796.     Erasmus  Darwin,  1731-1802. 

The  physiology  of  tlie  latromatlieraatical,  ov  latro- 
meclianical,  or  latrophysical  School  devoted  diief  consid- 
eration to  tlie  solid  parts  of  the  economy,  whose  form 
and  function  it  strove  to  discover  and  demonstrate  by  tlie 
aid  of  exact  methods, — that  is,  by  calculation  and  physical 
apparatus.  Thus,  it  explained  digestion  as  mechanical 
trituration;  secretions  were  referred  to  variation  in  resist- 
ance of  parts  in  the  vascular  system;  warmth  was  supposed 
to  be  due  to  friction  of  the  blood-corpuscles;  health  con- 
sisted in  the  undisturbed  performance  of  the  physical  and 
mechanical  processes  of  the  body.  Diseases  were  explained 
inversely:  the  blood,  under  diseased  conditions,  was  held  to 
contain  pointed  and  angular  crystals,  which  irritated  as 
they  passed  through  the  pores,  or  disturbed  because  they 
could  not  so  pass. 

The  first  to  enunciate  these  views  was  Santoro,  or 
Sanctorius,  who  flourished  from  1561  to  1635,  and  was 
for  a  while  professor  at  Padua.  He  taught  how  to  in- 
vestigate the  pulse  by  an  instrument  of  his  own  contri- 
vance, and  how  to  study  the  temperature  by  means  of 
a  species  of  thermometer,  which  was  probably  his  own 
invention.  (This  instrument,  by  the  way,  was  invented 
about  this  time;  Drebbel  [1572-1634]  is  regarded  as  the 
inventor  of  the  air-thermometer,  Galileo  [1574-1642]  of 

(171) 


172  THE    HISTORY    OF    MEDICINE. 

the  spirit-thermometer,  and  Roemer  [1644-1710]  of  the 
mercurial  thermometer.)  Santoro  studied  tlie  phenomenon 
of  transpiration,  and  constructed  apparatus  for  bathing 
bed-ridden  individuals;  lie  found  that  in  twenty-four  hours 
the  insensible  transpiration  through  the  skin  amounted  to 
I5  kilogrammes, — which  result,  compared  with  the  results 
of  the  present  day,  determined  by  the  most  complete 
observations,  is  only  twenty  per  cent,  too  high,  and  proves 
how  accurately  he  investigated.  The  important  role  of 
the  perspiration,  which  he  pointed  out,  was  made  use  of 
by  the  iatrochemists  to  vindicate  their  terrific  sweat-cures. 

Borelli  (1608-1679),  of  Naples,  is  usually  regarded, 
however,  as  the  founder  of  the  iatro mechanical  school. 
Of  a  quarrelsome  disposition,  he  could  not  stay  long  in 
any  one  place,  though  he  ultimately  settled  in  Rome, 
where  he  joined  the  circle  of  savants  wlio  gathered 
round  Christina,  the  daughter  of  Gustavus  Adolphus,  who 
had  become  a  convert  to  Catholicism.  Finally  Borelli 
entered  a  monastery.  His  services  related  mainly  to  phys- 
iology, where,  like  Descartes,  he  followed  purely  mathe- 
matical principles ;  he  explained  the  action  of  the  muscles 
by  the  laws  of  the  lever,  calculated  the  mechanical  work 
done  by  the  heart,  and  correctly  ascribed  inspiration  to 
muscular  action.  He  was  the  opponent  of  iatrochemistry, 
and  claimed  there  was  no  such  thing  as  corruption  of  the 
blood.  His  pupils  and  followers — like  Bellini  (1643-1704), 
of  Florence,  who  became  professor  in  Pisa  at  tlie  early 
age  of  nineteen,  and  Baglivi  (1668-1707),  a  pupil  of 
Malpighi,  and  a  man  of  universal  education — carried  out 
and  elaborated  the  first  expressions  of  this  autlior.  Borelli 
was  the  author  of  the  oft-quoted  maxim :  "  He  who 
diagnoses  well  cures  well." 

The  iatromathematical  system  held  ground  for  some 
time  in  Italy,  and  also  found  followers  elsewhere.  For 
instance,  Dodart  (1664-1707).  of  Paris,  explained  the 
voice  on  the  mechanical  princiy)les  enunciated  by  Borelli 


THOMAS    SYDENHAM. 


173 


and  by  Quesiiay  (1694-1774),  the  first  permanent  secretary 
of  the  Academy  of  Surgery  in  Paris.  In  EngUind  this 
explanation  was  adopted  by  a  number  of  followers,  none 
of  whom,  however,  was  eminent  enough  to  justify  special 
mention  here.  In  Germany  it  obtained  a  certain  amount 
of  favor,  but  seems  not  to  have  attracted  any  very  eminent 
disciples. 

The  iatromechanical  school  ran  a  course  not  unprofit- 
able to  science,  yet  was  unfruitful  of  real  advance  in  the 


Fig.  23.— Thomas  Sydenuam. 

(From  a  steel  engraving  of  a  painting  by  H.  F.  Rose.) 


domain  of  practical  medicine.  The  man  of  this  particular 
age,  who,  more  than  any  other,  exerted  an  influence 
destined  to  be  prolonged  even  to  the  present  time,  and 
probably  much  longer,  who  had  a  cool,  clear,  and  un- 
prejudiced spirit,  and  who  sought  the  true  value  of 
medicine,  and  recompense  for  the  same  in  the  benefits 
whicli  it  brings  to  the  sick,  without  scorning  or  neglecting 
its  scientific  side,  was  Thomas  Sydenliam,  born  at  Win- 
ford  Eagle  in  1624,  a  student  at  Oxford  in  1642,  and 
recipient    of  a    bachelor's    degree    of  medicine   in    1648. 


174  THE    HISTORY    OF    MEDICINE. 

Tlie  next  fifteen  years  of  his  life  we  know  practically 
nothing  ot,  save  that  he  spent  some  time  in  Monlpellier 
pursuing  his  medical  studies.  In  1663  he-  hecame  a 
member  of  the  Royal  College  of  Physicians,  but  did  not 
take  his  degree  of  Doctor  until  1676, — thirteen  years 
before  his  death.  His  chief  work — Medical  Observa- 
tions— is  said  to  have  been  originally  written  in  English, 
and  translated  into  Latin ;  it  first  appeared  in  1666, — the 
year  when  fire  and  plague  devastated  London.  He  died 
of  gout  in  1689,  and  was  buried  in  Westminster  Abbey. 
During  the  earliest  years  of  the  plague  in  London  he  fled, 
as  was  the  general  custom  of  that  day. 

His  model  was  Hippocrates.  In  pathology  he  was 
a  humoralist  without  being  a  theorist.  He  knew  only 
one  standard, — observation  and  experience.  Sharing  the 
opinions  of  his  day,  he  laid  but'  little  weight  upon  anatomy 
and  physiology;  yet  he  recognized  their  value  when 
employed  in  the  production  of  hypotheses.  He  conceived 
of  disease  as  active,  operative, — a  natural  effort  of  the 
body  to  remove  morbid  material  from  the  blood;  if  this 
effort  is  violent  and  speedy,  we  have  to  do,  he  says,  with 
an  acute  disease,  but  if  slow  and  difficult,  the  condition 
is  chronic.  Fever  was  supposed  to  result  mostly  from 
cold  or  from  epidemic  influences.  As  causes  of  disease, 
he  considered  unknown  influences  and  changes  of  the 
atmosphere  very  important.  In  his  special  pathology 
"inflammation  of  the  blood"  played  the  chief  role,  and 
upon  it  were  made  to  depend  nearly  all  acute  and  some 
chronic  diseases.  He  arrived  at  what  he  called  the 
"  healing  power  of  Nature,"  for  which  he  made  great 
claims  in  his  description  and  observation  of  epidemics : 
but  he  believed  there  always  remained  a  good  deal  for 
the  physician  to  do,  and  in  treating  syphilis  he  even  gave 
mercury  until  two  kilogrammes  of  saliva  were  discharged 
daily.  As  compared  with  the  therapeutics  of  that  day 
his    were   manifestly    simple, — and    yet   he  employed,  for 


SIR    THOMAS   BROWNE.  175 

example,  eigliteen  different  herbs  in  one  prescription,  and 
that  merely  an  ointment.  The  unreliability  of  the  action 
of  drugs  induced  him  to  rely  upon  specifics,  as  did 
Paracelsus,  but  he  acknowledged  only  one  such, — the 
then  new  discovery,  cinchona, — not  even  allowing  mercury 
such  a  position  in  the  treatment  of  syphilis.  Such  drugs 
as  he  chose  were  mainly  from  the  vegetable  kingdom. 

The  great  importance  of  Sydenham,  and  all  his  state- 
ments, so  far  as  we  are  concerned,  centres  about  his 
struggle  for  the  elucidation  of  the  healing  power  of  Nature, 
and  for  simple  observation  and  simpler  treatment,  as 
opposed  to  the  overgrown  luxuriance  of  previous  systems 
and  theories.  He  became  the  standard-bearer  of  his  age 
in  his  return  to  Hippocrates's  method  and  art  of  healing, 
which  are  founded  on  the  nature  of  tilings  and  on  the 
limits  of  human  ability. 

Sydenham  was  vehemently  opposed  by  Richard  Morton 
(162.5-1648),  of  London,  who,  like  Fernel,  considered  all 
diseases  to  be  a  poisoning  of  the  vital  spirits.  Sydenham 
was  also  antagonized  by  Gideon  Harvey,  who  ridiculed 
his  medical  contemporaries  without  stint,  because  most 
of  them,  for  febrile  disease,  gave  cathartics  from  the 
second  day,  and  began  treatment  with  emetics.  With 
delightful  satire  Harvey  divided  the  physicians  of  the 
day  into  six  classes:  the  Ferrea,  Asinaria,  Jesuitica, 
Aquaria,  Laniaria,  and  Stercoraria,  according  as  their 
favorite  systems  of  treatment  were  the  administration  of 
iron,  asses'  milk,  cincliona,  mineral  water,  venesection,  or 
purgatives. 

Sir  Thomas  Browne  (1605-1682),  who  still  enjoys  a 
great  reputation,  was  the  author  of  the  works  entitled 
Religio  Medici  and  Inquiries  into  Vulgar  and  Common 
Errors.  The  latter  appeared  in  1646,  but  does  not  seem 
to  have  protected  its  author  from  the  worst  error  of  his 
age, — viz.,  superstition, — since,  in  1664,  he  swore  that 
two  condemned  old  women  were  actual  witches. 


176  THE   HISTORY   OF    MEDICINE. 

Having  considered  the  progress  of  medicine  during 
the  seventeenth  century,  it  may  be  well  to  glance  likewise 
at  surgical  progress.  Among  the  Italians  Santoro,  already 
spoken  of  as  the  inventor  of  various  instruments,  should 
be  mentioned ;  also  Valsalva,  who  obtained  a  sound  repu- 
tation as  an  operator,  employed  the  ligature,  and  recom- 
mended a  starvation  plan  for  treating  aneurism ;  Magati 
(1579-1647),  who  contended  against  the  abuses  of  treating 
wounds  by  filling  them  with  plasters,  balsam,  poultices, 
tents,  etc.,  and  of  changing  the  dressing  several  times  a 
day, — once  in  four  days  was  better,  he  said ;  Severino 
(1580-1656),  first  a  lawyer,  then  a  professor  at  Naples, 
and  later  an  eminent  surgeon,  a  good  anatomist,  and  a 
particular  friend  of  the  actual  cautery;  Marchetti  (1589- 
1673),  a  bold,  versatile  operator  of  Padua;  and  Borri,  of 
Milan  (1625-1695),  skilled  as  an  operator  and  an  oculist 
but  better  known  because  of  his  sad  fate,  since  he  died 
in  the  prison  of  the  Inquisition,  after  a  prison-life  of 
twenty-five  years,  on  account  of  too  liberal  religious  views. 
There  were  also  numerous  other  Italian  surgeons  who 
made  a  name,  especially  in  plastic  surgery,  and  particularly 
in  that  branch  of  it  named  rhinoplasty,  by  whose  efforts 
one  method  of  manufacturing  a  new  nose  came  to  be 
known  as  the  "  Italian  method." 

France,  we  must  remember,  was  the  home,  during 
tliis  century,  of  Richelieu,  Mazarin,  Louis  XIV,  Corneille, 
Racine,  Moliere,  Fenelon,  la  Fontaine,  Boileau,  Bossuet, 
and  many  other  men  eminent  in  literature  and  science. 
Durinj>-  this  centurv  the  French  laid  the  foundation  for  that 
leadership  in  surgery  which  they  maintained  for  nearly  two 
centuries.  Let  us  mention,  among  their  surgeons.  Morel, 
who  invented  the  tourniquet  at  the  siege  of  Besancon,  in  the 
year  1674.  There  was  also  Jean  Baptiste  Denis  (who  died 
in  1704),  physician  to  Louis  XIV,  who  performed  the  first 
transfusion  of  blood  in  man.  (Transfusion  of  the  blood  of 
the  young  into  the  veins  of  the  old,  for  the  purposes  of 


FRERE  JACQUES  AND  OTHER  FRENCH  SURGEONS    177 

rejuvenation,  was  recommended  by  Libavius,  in  1715,  and 
CoUe,  of  Padua,  gave  it  new  support  by  describing-  a 
method  for  its  performance.  In  1729  Boyle  practiced 
transfusion  on  dogs.  The  London  iaculty  sought  the 
value  of  the  operation  after  excessive  haemorrhage,  and 
Edmund  King,  physician  to  Charles  II,  in  1665  practiced 
transfusion  from  vein  to  vein.  But  Denis  was  the  first  to 
carry  out  the  operation  with  lamb's  blood  upon  a  patient 
sinking  under  excessive  venesection, — an  operation  which 
was  very  much  abused  at  this  time.)  It  was  in  this  cent- 
ury that  the  French  family  of  lithotomists — the  Collots — 
distinguished  themselves  in  their  special  line.  The  last 
member  of  the  family,  Francois,  died  in  1706.  Their 
specialty  must  have  found,  at  that  time,  considerable  more 
material  than  comes  to  the  front  to-day. 

Among  the  general  surgeons  of  France  were  de  Marque 
(1618),  who  distinguished  himself  as  a  bandager;  Bienaise, 
who  invented  the  bistoury  cache  (1601-1631);  de  Launay 
(1649),  monk  and  lithotomist;  Goursaud,  who  survived 
his  century,  and  who  was  the  first  to  describe  stercoral 
incarceration ;  Duverney,  who  demonstrated  the  growth 
and  nutrition  of  the  bones  by  periosteum ;  Lambert,  who 
practiced  injections  in  hydrocele ;  Andry,  of  Lyons,  who 
wrote  of  orthopaedic  surgery  and  originated  the  name 
ortliopcedics  ;  Pierre  Dionis  (who  died  in  1718),  surgeon 
to  the  Empress  Maria  Theresa,  famous  in  his  art,  and  who 
first  emphasized  the  effects  of  rickets  upon  the  pelvis ;  and 
Boulot,  better  known  as  Beaulieu  (1671-1714),  who  ad- 
vanced himself  from  being  a  soldier  and  a  day-laborer  to 
become  a  physician,  a  famous  lithotomist,  and  surgeon. 
He  finally  joined  the  Franciscan  order,  where  he  obtained 
the  name  of  Frere  Jacques,  under  which  title  he  passed 
for  the  inventor  of  lateral  lithotomy.  Then  there  were 
Saviard  (1656-1702),  surgeon-in-cliief  in  the  Hotel-Dieu, 
who,  among  other  things,  determined  the  seat  of  hernial 
strangulation   to  be    often  in   the  neck  of  the  sac ;   and 


178  THE    HISTORY    OF   MEDICINE. 

Georges  Mareschal  (1658-1736),  surgeon  to  Louis  XIV, 
one  of  the  founders  of  the  Academy  of  Surgery,  wlio  has 
a  record  of  eight  lithotomies  performed  in  half  an  hour, 
and  who  became  famous  for  his  services  in  improving  the 
schools  of  surgery  in  France. 

In  this  (the  seventeenth)  century,  also,  ophthalmology 
was  much  cultivated  in  France,  although  it  was  assigned 
to  the  despised  surgeons.  Those  who  won  most  renown 
in  this  line  were  Maitre  Jean  and  Brisseau,  who  divide  the 
honor  of  first  recognizing  the  seat  of  true  cataract.  During 
this  period,  also,  Duverney,  Professor  of  Anatomy  at  Paris, 
was  the  first  to  systematically  describe  diseases  of  the  ear 
in  accordance  with  their  anatomical  seat. 

In  Spain  scliolarsiiip  sank  more  rapidly  during  this 
century  than  among  any  other  people  in  history,  due 
mainly  to  the  loss  of  their  political  supremacy  and  their 
commerce  to  the  Dutch  and  English,  and  to  the  utter 
failure,  at  home,  of  their  efforts  to  introduce  true  unity 
of  faith.  In  these  efforts  the  industrious  Moors  were 
excluded,  under  Philip  III.  In  art  they  maintained  their 
standing, — attaining,  in  fact,  in  Murillo,  the  acme  of  their 
fame;  but  in  otlier  branches  of  industry  they  rapidly 
degenerated.  Students  of  history  will  readily  understand 
how  little  leisure  the  Spaniards  had  at  this  time  to  devote 
to  the  cultivation  of  science,  including  medicine  and  surgery. 
Of  the  two  men  who  are  mentioned  during  this  century  as 
Spanish  surgeons,  namely,  Almeida  and  Ayala,  we  know 
practically  nothing. 

The  Germans  gained  no  sucli  store  of  knowledge  from 
their  experience  during  the  Thirty  Years'  AVar  as  did 
the  French  during  their  campaigns.  The  barber-surgeons, 
for  the  most  part,  still  reigned  supreme,  and  their  guild 
contained  some  men  of  ability  and  independence  of  thought. 
Tlie  most  notable  man  of  the  times  Avas  Fabricius  Hildanus 
(1560-1634).  Of  him,  however,  I  have  already  spoken  as 
belonging  rather  to  the  previous  century.     He  was  the  first 


Fig.  24.— Stkaight  8a\vs  and  Divers  Scraping  Tools,  Wherewith  thk 

Skull,  Being  Rotten  or  Having  a  Fissure,  is  Scrapeb  Away. 

/  and  II.  straight  saws.    Ill  to  X,  various  forms  of  scraping  tools. 

(From  The  Chyrurijeon' a  Store-Jimisf,  by  Joh.annes  Scultetiis,  a  famous  physicinii  and  surgeon  of 

Ulme  iu  Suevia.     English  translation  published  in  London  in  1674.) 


180  THE   HISTORY   OF   MEDICINE. 

learned  German  surgeon  recognized  and  esteemed  as  such 
by  his  contemporaries.  He  was  distinguished,  also,  as  an 
ocuUst  and  aurist,  and  removed  a  ^mrticle  of  iron  from  the 
cornea  by  means  of  a  magnet.  A  man  of  great  operative 
genius,  and  a  born  surgeon,  was  Purmann  (1648-1721), 
who  greatly  lamented  the  low  condition  of  surgery  in  Ger- 
many, and  regarded  a  knowledge  of  anatomy  as  the  prime 
requisite  for  the  surgeon ;  he  employed  the  speculum  in  the 
diagnosis  of  syphilis,  although  it  has  been  Ricord's  boast 
that  this  was  his  own  idea.  Scultetus  (1595-1645),  of 
Ulra,  was  a  famous  surgical  writer  of  this  period,  and  a 
bandage  of  his  devising  is  still  in  frequent  use,  and  bears 
his  name.  Muralt,  of  Ziirich,  was  also  a  capable  surgeon 
(1655-1733). 

The  Dutcli  had  but  few  men  during  this  century  who 
enjoyed  any  reputation  as  surgeons.  The  best  among  them 
was  Rau  (1658-1719),  who,  from  being  a  poor  boy,  became 
a  barber,  traveled  extensively,  and  was  finally  made  Pro- 
fessor of  Anatomy  and  Surgery  in  Leyden,  where  he 
introduced  the  innovation  of  teaching  practical  surgery 
upon  the  cadaver.  He  was  especially  famous  as  a  lith- 
otomist  after  the  method  of  Frere  Jacques,  although  he 
did  not  give  instruction  on  this  subject  in  his  lectures. 

By  the  way,  it  is  an  interesting  fact  that  the  clinical 
histories  of  many  operations  for  stone  during  the  seventeenth 
century  were  related  in  verse,  and  illustrated  with  plates. 
Harvey's  vivisections  were  also  related  in  verse. 

Now,  for  the  first  time,  do  we  begin  to  hear  of 
English  surgeons  and  English  surgery.  The  most  prom- 
inent, as  well  as  almost  the  earliest,  was  Richard  Wise- 
man (1595-1686),  ordinary  surgeon  of  James  I,  called 
sometimes  the  "  Pride  of  England  "  and  sometimes  the 
"Pare  of  England," — a  bold,  judicious  operator,  who  took 
hold  of  every  novelty  and  who  accepted  the  ligature  of 
Pare  (always  having  the  actual  cautery  at  hand,  in  case  the 
ligature  should  fail);   he  also  amputated   through  sound 


Fig.  2o.— Sukgicai>  Thkatmknt  of  Certain  Dislocations. 

J"  shows  the  reduction  of  the  ankle-bone.    J/ shows  tlie  extension  and  im- 
pulsion of  the  spina  dorsi  dislocated  externally. 

(From  The  fhi/riirgeon'i  Ston-houif.  hv  Johannes  Scnltetns,  1674.) 


182  THE   HISTORY   OF   MEDICINE. 

parts,  favored  operating  for  strangulated  hernia,  and 
employed  the  trephine  zealously.  The  first  recorded 
operation  for  external  urethrotomy  for  the  relief  of  stricture 
is  mentioned  in  Wiseman's  writings. 

There  were  also  William  Cowper  (1666-1709),  a 
famous  anatomist  and  surgeon  ;  and  Woolhouse,  a  famous, 
but  ignorant,  itinerant  oculist.  Sir  Christopher  Wren, 
architect  of  St.  Paul's,  was  the  first  who  devoted  attention 
to  injecting  medicine  into  the  veins, — a  subject  studied 
again  much  later  and  recently  once  more  taken  up.  His 
example  (in  1667)  was  followed  by  others,  whose  experi- 
ments demonstrated,  as  we  know  to-day,  that  the  effects 
which  follow  the  intravenous  administration  of  drugs  are 
the  same  as  follow  administration  by  the  mouth. 

Midwifery  during  the  seventeenth  century  advanced 
even  more  rapidly  than  its  mother-science  surgery.  The 
accouchement  of  women  was  intrusted  in  many  cases  to  the 
care  of  educated  men,  who  contributed  not  a  little  to  the  art. 
Anatomy  and  physiology  contributed  also  their  quota  to  a 
clearer  knowledge  of  these  diseases.  The  obstetric  forceps 
were  for  so  long  a  time  kept  secret  that  they  were  of  small 
benefit  at  first  to  the  obstetric  art.  Among  the  French 
who  were  especially  prominent  as  promoters  of  midwifery 
must  be  mentioned  Marguerite  de  la  Marche,  chief  midwife 
of  the  Hotel-Dieu ;  Francois  Mauriceau,  President  of  the 
College  of  St.  Come ;  Jules  Clement  Delamotte,  who  was 
also  a  skillful  surgeon;  and  Portal,  who  first  proposed 
version  by  one  foot.  Among  the  Germans  a  few  midwives 
distinguished  themselves  as  independent  observers,  most  of 
all  Justine  Siegemundin,  daughter  of  a  minister,  who  de- 
voted herself  to  midwifery  with  such  success  that  she  be- 
came court  midwife  ;  she  recommended  puncture  of  the 
membranes  for  the  production  of  artificial  delivery,  and 
especially  advocated  bimanual  version. 

But,  perhaps,  the  most  significant  advances  were  made 
in  the  direction   of  studies   in  anatomy,  physiology,  and 


ANATOMICAL   RESEARCHES.  183 

pathology.  The  history  of  the  circulation  we  have  already 
taken  up.  After  Harvey's  time,  and  largely  because  of  his 
researches,  physiologists  were  divided  into  two  parties  with 
regard  to  the  origin  of  life.  These  parties  were  known  as 
animists  and  animalcullsts.  It  was  largely  by  the  later 
researches  of  High  more  (1613-1685)  upon  the  anatomy  of 
the  testis  and  the  epididymis,  supplemented  by  those  of 
Aubrey  in  Florence  concerning  the  ovaries  (which  had 
been  previously  considered  as  female  testicles),  and  the  re- 
searches of  Stenon  concerning  the  muscular  nature  of  the 
uterus,  that  a  better  knowledge  of  reproduction  was  estab- 
lished. De  Graaf  (1641-1673),  a  physician  of  Delft,  Hol- 
land, pointed  out  the  ovarian  follicles,  known  to-day  under 
his  name,  while  Swammerdam  (1637-1686)  studied  the 
comparative  anatomy  of  the  ovaries, — and  was,  by  the  way, 
the  first  to  prove  that  the  queen  bee  is  a  female.  Needham, 
the  London  anatomist  and  physician,  and  Hoboken,  of 
Utrecht,  described  more  accurately  the  placenta  and  the 
coverings  of  the  ovum. 

Anatomical  discoveries  crowded  along  about  this  time. 
For  instance,  Wharton  (1610-1673)  discovered  the  sub- 
maxillary duct,  named  after  him;  Glisson  (1647-1671) 
studied  the  liver  and  recognized  its  capsule,  that  still  bears 
his  name ;  Nuck  injected  the  lymphatics  with  quicksilver, 
and  studied  the  glands  especially ;  Stenson  discovered  the 
excretory  duct  of  the  parotid,  and  Rivinius  (his  name  being 
translated  in  German,  Bachmann)  found  the  sublingual 
duct ;  Peyer,  Schafhausen,  and  Brunner,  the  latter  a  pro- 
fessor in  Heidelberg,  discovered  tlie  intestinal  glands  which 
bear  their  names;  Wirsung,  of  Bavaria  (who  was  assas- 
sinated in  1643  by  another  physician),  discovered  in  the 
dissecting-room  of  Vesalius,  at  Padua,  the  excretory  duct 
of  the  pancreas ;  Pacchioni  found  the  bodies  named  after 
him  in  the  dura  mater ;  Havers,  of  London,  discovered  the 
synovial  glands  and  the  so-called  Haversian  canals  ;  Cow- 
per,  already  mentioned,  discovered  tlie  small  glands  named 


184  THE   HISTORY    OF   MEDICINE. 

after  him,  located  in  front  of  the  prostate,  and  Bartholin 
yet  other  glands,  in  the  labia,  which  bear  his  name ;  Mei- 
bom,  professor  in  Helrastadt,  discovered  the  small  glands 
in  the  eyelids  which  are  named  after  him.  Besides  these, 
many  other  discoveries  might  be  recorded  here,  did  time 
permit.  One  other,  however,  deserves  to  be  mentioned, 
with  which  the  name  of  Schneider  (1614-1680)  must 
always  be  honorably  connected.  He  described  the  mucous 
membrane  of  the  nose  and  demonstrated  anatomically  and 
clinically  that  not  the  brain,  but  this  membrane,  secretes 
the  mucous  discharge  during  fluxes  from  the  nose.  This 
overthrew  at  once  and  forever  the  ancient  doctrine,  which 
included  so  many  and  various  "  catarrhal "  diseases.  I 
might  add  also  that  the  best  and  most  complete  description 

Bescnptimi  of  Fig.  26. — "  Of  the  corruption  of  tbe  bones  of  the  arm  and  shin, 
even  as  far  as  the  marrow ;  of  the  shin-bone  broken  witli  a  wound  and  the  bones 
sticking  out  and  bound  with  swathe-bands  brought  circularly  about ;  and  of  the 
cutting  oflF  of  the  end  of  the  hand  or  foot.  /  represents  the  corruption  of  the 
bone  and  of  the  marrow  of  the  shin-bone,  //represents  the  shin-bone  wholly  cor- 
rupted and  rotten.  ///  represents  the  place  where  the  coiTupt  bone  was  situated 
and  was  now  pulled  forth  with  tiie  pincers.  Fis  that  shin-bone  corrupted,  which 
the  patient  laid  up  for  a  memoiial.  F/is  the  bone  of  the  right  arm  corrupted.  VII 
represents  the  bone  of  the  arm  totally  corrupted  and  sharp,  which  was  pulled  away 
with  the  pullers,  but  by  pieces,  without  any  noise  or  pain.  VIII  shows  the  place 
where  the  corrupt  bone  of  the  arm  lay,  which  was  now  pulled  forth,  which  Nature 
filled  up  with  a  callous,  so  that  the  patient  could  perform  country  business  without 
any  impediment.  The  patient  was  a  countryman  of  Pappatavia,  whose  arm  a 
souldier  broke  in  four  places,  without  any  wound,  anno  1636.  IX  is  a  fracture  of 
the  shin-bone  with  a  wound,  and  laying  the  bone  naked.  Xis  the  bone  of  the  shin 
with  a  wound,  broken,  with  bones  sticking  forth,  and  bound  w  ith  bands  not  cross- 
wise, but  circularly  brought  about  and  laid  within  the  capsula  as  it  ought  to  be. 
XI\&  a  hand  affected  with  a  secret  canker  which  is  cut  off  in  the  sound  part,  namely 
at  the  end  of  the  radius  and  cubit  bone.  XII  is  a  hand  that  is  sphacelated,  which, 
being  laid  upon  the  block  (7?),  is  amputated  in  the  sound  ends  of  the  radius  and 
arm-bone  with  a  chizel  {W),  contrary  to  Hildanus,  with  good  success.  XIII  is  a 
basin  fliled  with  oxycrat,  in  which  swims  a  bladder,  which,  being  wet,  must  be 
applied  to  the  mutilated  part.  XIV  are  two  swathe-bands  wrapt  together  {F  and 
©),  whereof  each  hath  two  ends,  to  bind  the  arm,  whereof  the  hand  at  the  end  is 
cut  off.  XV  represents  a  foot  that  is  sphacelated,  which  is  taken  off  in  the  morti- 
fied part,  near  the  sound  part  with  a  pair  of  pincers.  The  mortified  part  h?ing  re- 
moved, the  rest  of  the  putrefaction  is  consumed  with  red-hot  irons  until  the  patient 
feels  the  force  of  the  fire.  After  this  two  plagets  are  anointed  with  Hildanus,  his 
unguent  Egyptiac,  which  are  applied  to  the  escar ;  lastly,  long  plaisters  (/)  being 
laid  upon  it,  the  foot  mutilated  is  bound  with  a  wet  band  {K)  as  far  as  the  knee, 
as  the  hand  is  unto  the  middle  of  the  arm.  XVI  are  divers  sorts  of  iron  instru- 
ments and  made  red  hot,  both  to  consume  the  remainder  of  the  putrefied  part  and 
are  also  fit  to  stop  the  flux  of  blood." 


Fig.  26.— Various  Operations  on  thk  Arms  and  Lower  Limbs. 

(From  The  C/iyrnri/mii'i  Store-house,  by  Johannes  Scultetns,  IfiTJ.) 


186  THE    HISTORY    OF    MEDICINE. 

of  the  entire  central  nervous  system  which  had  been  given 
up  to  this  time  was  furnished  by  Vieussens. 

By  the  middle  and  latter  portions  of  the  seventeenth 
century  most  of  the  better  physicians  and  surgeons  had 
either  assumed  offices  and  positions  in  which  they  were 
supported  by  the  State,  or  were  settled  in  permanent  resi- 
dences, which  was  not  the  case  with  the  mass  of  physicians 
in  the  sixteenth  century.  As  a  residt  the  reputation  of  the 
entire  profession  began  to  improve,  while  the  unlimited 
license  and  absolute  freedom  of  practice  prevailing  during 
the  Middle  Ages  were  almost  entirely  done  away  witli. 
By  this  time  the  clerical  element  had  disappeared  almost 
entirely  from  medical  circles,  or  only  dabbled  in  certain 
specialties.  The  Thirty  Years'  War  was  fatal  to  the  su- 
premacy of  the  clergy  in  matters  of  public  health.  More- 
over, the  increase  of  international  intercourse  favored  tlie 
communication  of  medical  knowledge. 

The  physicians  of  this  period  were  more  occupied 
with  chemistry  and  physics  than  had  ever  been  the  case 
before.  Nevertheless,  this  was  also  tlie  sj^ecial  age  of 
alchemists  and  of  impecuniosity.  According  to  one  of  the 
classifications  of  the  time,  the  regular  profession  was  sup- 
posed to  include  physicians,  surgeons,  barbers,  regimental 
surgeons,  lithotomists,  batli-keepers,  midwives,  nurses, 
apothecaries,  druggists,  and  even  confectioners  and  grocers. 
Another  list  of  impostors  and  quacks,  equally  official,  was 
made  to  include  old  women,  village  priests,  hermits,  quacks, 

Description  of  Fig.  27. — "/  represents  the  breast  affected  with  an  ulcerated 
canker,  the  basis  whereof  is  thrust  tlirough  with  two  needles  drawing  after  them  a 
twisted  flaxen  thread,  //shews  how  the  chyrurgeon  takes  hold  with  his  left  hand, 
of  the  ends  of  the  threads  that  were  thrust  through,  and  with  his  right  hand  he 
takes  the  knife  and  wltli  that  he  cutteth  the  canker  out  by  the  roots.  ///  shews  a 
canker  cut  from  the  breast  weighing  six  physical  pounds.  IV  shews  how  the  chy- 
rurgeon, after  the  cutting  off  of  a  breast  ulcerated,  doth  lightly  cauterize  the  place 
with  a  red-hot  iron  at  least  to  corroborate  the  parts,  Fis  the  instrument  of  Hierom 
Fabritius  ab  A quapendente  wherewith  a  fistula  of  tlie  thorax  is  perforated.  F/is 
Sostratus,  his  band,  which  is  most  convenient  where  the  breast  is  affected  with  any 
disease  that  requires  binding.  F//  shews  how  Celsus  cured  the  sticking  forth  of 
the  navil  by  manual  operation.  VIII  is  a  truss  for  the  uavil  made  of  a  double 
cotton  liuDen  cloth." 


THE    ALCHEMISTS   AND    CHARLATANS, 


187 


iiroscopists,  Paracelsists,  Jews,  calf-doctors,  executioners, 
crystallomancers  (a  class  of  people — chiefly  Italian — who 
sought  after  crystals),  mountebanks,  vagrants,  magicians, 


Fig.  27.— Surgical  Operations  on  the  Breast,  etc. 

(From  The  Cliyrunjtoii's  Store-house,  by  Johannes  Scultetns,  1674.) 

exorcists,    monsters,    rat-catchers,  jugglers,    and    gypsies 
Veterinary  physicians  were  also  at  that  time  included  in 
this  class. 


188  THE    HISTORY    OF    MEDICINE. 

Anatomy  was  now  studied  more  from  human  bodies, 
and  was  authorized  by  statute.  This  was  especially  the 
case  in  non-German  institutions,  to  which  for  this  reason 
students  flocked  in  great  numbers.  In  Dresden,  so  early 
as  1617,  there  was  a  dissecting-room  in  which  stuffed 
birds,  at  that  time  a  great  rarity,  and  similar  curiosities 
were  preserved.  The  study  of  anatomy  was  at  a  low  ebb 
in  Germany ;  so  that  when  Rolfink,  in  1629,  arranged  at 
Jena,  which  was  then  the  most  popular  German  university, 
for  two  public  dissections  upon  executed  malefactors,  it  was 
considered  such  an  event  that  the  very  highest  authorities 
were  present.  But  the  peasantry  took  such  fright  at  this 
occurrence  that  for  a  long  time  afterward  they  watched 
their  cemeteries  by  night  lest  the  corpses  should  be  dug  up 
and,  as  they  said,  "  Rolfinked."  Vienna  did  not  possess  a 
skeleton  until  1658.  Strassburg  obtained  one  of  a  male  in 
1671,  and  several  years  later  one  of  a  female.  In  Edin- 
burgh an  anatomical  theatre  was  first  erected  in  1697  in 
Surgeons'  Hall.  It  is  worthy  of  remark  that  anatomical 
plates,  designed  to  be  lifted  off  in  layers,  existed  even  at 
this  period.  About  the  middle  of  this  century  there  arose 
a  dispute  at  the  bedside  of  the  Margrave  of  Baden,  between 
two  learned  professors  and  the  regular  court  physician, 
whether  a  plaster  to  be  applied  over  the  patient's  heart 
should  be  placed  in  the  middle  of  the  chest,  according  to 
Galen,  or  upon  the  left  side.  The  dispute  was  settled  by 
opening,  before  the  eyes  of  the  noble  patient,  a  hog,  by 
means  of  -which  it  was  demonstrated  that,  as  a  matter  of 
fact,  the  heart  of  the  hog  lay  on  the  left  side.  So  convinced 
was  his  excellency  that  he  dismissed  the  ordinary  pliysician, 
who  had.  held  a  contrary  opinion  as  to  the  position  of  a 
nobleman's  heart. 

The  general  barbarity  and  immorality  of  this  century 
were  conspicuous,  especially  among  the  upper  classes,  and 
by  its  close  had  spread  from  France,  became  naturalized 
in   both  Germany  and  Italy,  and  extended  even  to  the 


PRETENSIONS   OF   THE    "MEDICI   PURI."  189 

universities,  their  professors,  and  their  students.  The  life  of 
the  latter  during-  this  period  was  more  vulgar  and  rude  than 
ever  before,  and  almost  more  so  than  ever  since.  Pennal- 
ism- — tliat  is  to  say,  barbarity  toward  junior  students — be- 
came unbounded,  so  that  outbreaks  occurred  even  during 
lectures.  At  last  the  State  authorities  were  compelled  to 
interfere.  Student  outrages  were  very  frequent  and  often 
fatal,  and  their  outbursts  were  disgraceful  in  the  extreme. 

Only  in  France  was  instruction  in  surgery  well  regu- 
lated, for  this  was  the  only  country  which  possessed  a 
proper  surgical  college.  Practical  instruction  was  imparted 
to  mid  wives — in  Paris  through  a  special  institution,  in 
Germany  through  the  Midwives'  Guild ;  the  barbers,  too, 
continued  to  receive  instruction  from  their  guilds;  while 
instruction  in  pharmacy  was  given  by  the  master-apothe- 
caries, too  often  dogmatically  and  even  farcically,  serving 
as  objects  for  the  keen  satire  of  Moliere.  The  expenses  of 
graduation  were  very  great,  and  the  ceremonies  sometimes 
lasted  two  days. 

In  another  way  this  same  seventeenth  century  might 
be  characterized  as  one  of  aggrandizement  for  physicians, 
— that  is,  as  one  during  which  their  position  was  improved 
in  the  eyes  of  the  public  and  better  supported  by  the 
State.  The  physicians  proper — the  '■'■  medici  'puri" — were 
still  persons  of  the  profoundest  gravity,  with  fur-trained 
robes,  perukes,  canes,  and  swords,  when  matters  were 
prosperous,  who  for  their  lives  would  do  nothing  more  than 
write  prescriptions  in  formal  style,  everything  else  being 
considered  beneath  their  dignity, — even  as  they  affect  in 
England  to-  day.  They  demanded  to  be  called  in  every  case, 
however,  even  though  they  knew  nothing  about  it,  claim- 
ing that  only  by  means  of  their  presence  could  things 
certainly  go  right.  Nevertheless,  in  dangerous  cases — for 
example,  during  the  plague — they  left  the  surgeons  alone, 
while  they  looked  upon  the  sick  through  the  windows.  In 
spite  of  this,  however,  they  were  generally  esteemed  and 


190  THE    HISTORY    OF   MEDICINE. 

often  sought  for,  as  well  in  public  as  in  private.  Some  of 
them  were  supplied  with  large  libraries  by  their  patrons  or 
through  their  positions  under  the  government,  and  most 
of  them  enjoyed  moderate  prosperity.  Their  pay  was,  lor 
the  most  part,  regulated  in  accordance  with  a  definite 
tariff,  while  the  State  gradually  cut  down  the  doctor's 
honorarium  to  the  pay  of  a  day-laborer.  During  that 
century  a  certain  physician  to  a  countess  in  Munich  re- 
ceived $25  as  his  annual  stipend.  For  being  present  at  a 
post-mortem  and  rendering  an  opinion  thereon,  each  phy- 
sician received  $1.75.  Surgeons  who  were  zealous  and 
eager  were  always  highly  esteemed ;  they  were  often  better 
educated,  in  many  respects,  because  of  their  extensive 
travels;  but  the  social  emancipation  of  the  surgeons  was 
not  completed  until  the  eighteenth  century.  About  this 
time  amputation  of  the  arm  was  supposed  to  be  worth  31 
marks  ($7.75);  of  the  leg,  41  marks;  or,  if  a  patient 
died,  half  this  price.  Lithotomy  cost  51  marks,  or  half 
of  that  if  the  patient  died.  For  cataract  operation  on 
one  eye  the  surgeon  received  17  marks;  for  a  like  opera- 
tion on  both  eyes,  25  marks. 

We  find  in  medicine,  as  in  other  branches  of  knowl- 
edge, that  each  succeeding  century  presents  its  added 
quota  of  imperishable  facts,  making  it  still  more  important 
than  its  predecessor.  We  may  say  that  the  fifteenth  cent- 
ury had  prepared  the  way  for  a  reforming  idealism  which 
was  the  principal  characteristic  of  the  sixteenth ;  and  that 
in  the  seventeenth  century  the  realistic  reaction  against 
this  same  idealism  showed  itself  in  the  church  and  the 
State  by  struggles  against  constituted  authority,  and  in 
medical  science  by  the  domination  of  inductive  philosophy. 
The  idealism  of  the  eighteenth  century  was  not  reformative 
and  humanistic,  but  revolutionary  and  humanitarian.  The 
unsettled  character  of  the  century's  events  may  be  charged, 
in  some  degree,  to  the  American  and  French  revolutions, 
with  their  interpretation  (and  their  attempted  attainment) 


INFLUENCE  OF  THE  FRENCH  REVOLUTION.      191 

of  the  so-called  "  riglits  of  man."  The  masses  were  now 
supposed  to  be  released,  and  philosophers  created  new 
doctrmes,  which  had  a  greater  influence  upon  the  times 
than  ever  had  philosophical  doctrines  before.  Rousseau, 
for  instance,  aroused  a  revolution  in  politics  and  education, 
while  skeptics  and  materialists  alike  strove  for  general 
enlightenment,  which  was  sadly  needed.  Among  the 
higher  classes  extravagance  and  immorality  prevailed  ex- 
tensively, among  the  lower  classes  poverty  and  ignorance. 
In  Germany  the  rulers  even  sold  their  subjects,  as  when 
Hesse-Cassel  sold  to  the  English  seventeen  hundred  merce- 
nary soldiers,  and  other  States  sold  smaller  numbers.  A 
criminal  code,  published  in  1769,  contained  seventeen 
copper-plate  engravings,  illustrating  various  methods  of 
torture.  A  physician  was  always  present  when  torture 
was  inflicted,  to  see  that  the  victim's  sufterings  were  not 
greater  than  he  could  bear.  This  inhuman  mode  of  elicit- 
ing testimony  was  last  practiced  in  Europe  in  1869,  in  the 
Swiss  Canton  of  Zug.  Popular  education  was  a  myth,  and 
the  children  of  bondmen  were  not  permitted  to  learn.  No 
wonder  the  French  revolution  was  hailed  with  joy  along 
the  Rhine,  where  it  swept  away  at  once  and  forever  the 
petty  rulers,  abbots,  and  bishops,  who  were  the  "blood- 
suckers "  of  the  people.  The  numerous  wars  of  the  cent- 
ury had  no  great  influence  upon  the  development  of  med- 
icine, except  in  the  direction  of  surgery. 

The  eighteenth  century  was  revolutionary  also  in  the 
introduction  of  freedom  of  religious  thought,  so  that  cler- 
ical physicians  disappeared  entirely  from  the  ranks,  save  a 
few  who  officiated  as  lithotomists,  like  Frere  Come,  or  as 
oculists,  like  Wrabetz,  the  latter  of  whom  was  even  a 
professor  in  Prague. 

This  was  the  century,  too,  of  Leibnitz  and  Kant,  of 
Linnaeus  and  Lavoisier,  as  well  as  of  Bach,  Haydn,  Beet- 
hoven, and  Goethe.  During  it  the  most  conspicuous  services 
in  nearly  all  branches  of  learning  were  rendered  by  the 


192  THE    HISTORY    OF   MEDICINE. 

Germans,  instead  of  by  the  Italians  and  English,  as  during 
the  preceding  century.  In  fact,  Germany  was  then  at  the 
zenith  of  her  glory,  and  supplied  an  impulse  for  all  other 
nations. 

The  influence  of  philosophy  and  the  natural  sciences 
became  also  more  and  more  marked.  At  the  head  of  its 
philosophers  must  be  placed  Leibnitz  (1646-1716),  who, 
by  his  own  writings  and  those  of  his  pupils,  created  a 
philosophical  school,  whose  influence  is  still  every  where  felt. 
His  doctrine  was  dualistic:  Matter  is  created  once  for  all, 
and  has  no  further  need  of  the  Creator.  As  concerns  the 
spiritual  world,  lie  assumed  minute,  indivisible,  intelligent 
beings,  called  monads, — constituents  of  all  bodies  and  all 
beings.  In  close  relation  with  him  stood  Kant,  while  in 
England  Locke  and  Hume  became  leaders  of  the  opposed 
and  materialistic  school,  declaring  the  brain  to  be  an  organ 
for  the  secretion  of  thought. 

Among  the  universities  founded  during  the  eighteenth 
century  were  those  of  Breslau,  1702;  Bonn,  1771  ;  Stutt- 
gart, 1781 ;  Pesth,  1794;  Gottingen,  1737;  and  Erlangen, 
1743.  Medicine  was  also  cultivated  in  learned  societies, 
which  increased  constantly  in  numbers.  In  1744  Frederick 
the  Great  united  two  other  societies  into  his  Royal  Academy. 
In  Switzerland,  in  1751,  was  founded  an  association  of 
physicians  and  naturalists,  while  in  France  royal  scientific 
societies  were  founded  at  Bordeaux, Montpellier,  Lyons,  and 
Dijon,  and  the  Royal  Medical  Society  of  Paris  lived  from 
1717  until  1788.  In  spite  of  all  these  opportunities  for 
enlightenment,  everything  was  not  yet  enlightened.  Then 
de  Haen  defended  the  existence  of  demons,  and  Maerz,  a 
well-known  theological  teacher,  in  1760  devoted  a  book  to 
witches  and  magic.  That  witclies  were  burned  publicly  is 
a  matter  of  history,  even  in  America.  So  late  as  1821 
there  was  a  statute  regarding  witches  in  Ireland,  and  they 
were  burned  in  Mexico  as  recently  as'  1877.  But  these 
are  flying  pictures  of  the  eighteenth  century,  which  are 


BOERHAAVE.  193 

meant  only  for  the  moment  to  illustrate  the  more  serious 
topic,  to  which  we  must  now  address  ourselves. 

First  of  all,  the  medical  systems  and  theories  of  the 
century.  Many  hundred  years  previously  Galen  had  orig- 
inated a  method,  which  deserves,  perhaps,  the  title  of  pure 
eclecticism.  The  first  purely  eclectic  system  similar  to  his 
originated  with  Boerhaave  (1688-1738),  perhaps  the  most 
famous  physician  of  his  or  any  other  century.     He  was  the 


Pig.  28.— Boerhaave, 

(From  a  steel  engraving  by  Fanstino  Anderloni  of  a  painting  by  G.  GararagUa.) 

son  of  a  clergyman  near  Leyden,  Holland,  and  was  one  of 
thirteen  children.  Originally  intended  for  the  clerical  pro- 
fession, he  had  studied  philosophy,  history,  logic,  meta- 
physics, philology,  mathematics,  as  well  as  theology,  with 
great  diligence.  His  education  was,  later,  directed  to  the 
study  of  medicine,  because  of  the  statement  that  the  purity 
of  certain  theological  doctrines  was  endangered  by  him. 
So  he  studied  chemistry  and  botany,  and  then  anatomy  and 


191  THE    HISTORY    OF   MEDICINE. 

medicine,  graduating  in  1693.  He  practiced  in  Leyden 
with  great  success,  and  was  offered  a  court  position.  In 
1709  he  was  tendered  the  chair  of  Medicine  and  Botany, 
and  in  1714  that  of  the  Practice  of  Medicine;  in  1718  he 
was  also  made  Professor  of  Chemistry.  In  all  of  these 
positions  he  displayed  the  greatest  capacity.  He  was  a 
clinical  teacher  of  rare  talent,  and  soon  acquired  such 
reputation  as  to  attract  to  Leyden  student's  from  all  parts 
of  the  world  in  such  numbers  that  no  lecture-room  in  the 
university  could  contain  them.  He  was  the  first  to  give 
separate  lectures  on  the  subject  of  ophthalmology,  and 
employed  the  magnifying-glass  in  examining  the  eye.  As 
a  practitioner  he  was  no  less  popular,  and  he  left  an  estate 
valued  at  two  million  dollars.  He  was  so  famous  that, 
when  a  Chinese  official  addressed  a  letter  "To  the  Most 
Famous  Physician  in  Europe,"  it  reached  him  safely.  He 
made  no  distinction  in  his  patients,  and  compelled  Peter 
the  Great  to  wait  a  whole  night  for  his  turn  to  consult  him. 
His  most  eminent  pupils  were :  Haller,  Van  Swieten,  de 
Haen,  Gaub,  and  Cullen. 

Boerhaave's  influence  and  dignity,  which  were  astonish- 
ing, even  in  a  physician,  were  based  no  less  upon  his 
encyclopaedic  attainments  than  upon  the  benevolence  and 
purity  of  his  character.  He  was  free  from  disputatiousness 
and  vanity,  altliough  everywhere  regarded  as  an  oracle. 
His  universal  maxim  was:  "Simplicity  is  the  seal  of  truth," 
although  he  never  manifested  this  in  his  therapeutics.  He 
employed  the  thermometer  in  the  axilla  in  examining  his 
cases,  as  did  the  iatrophysicists  of  the  previous  century. 

His  doctrines  did  not  form  a  new  system,  but  rather  a 
composite  of  earlier  systems.  He  stands  also  in  the  anom- 
alous position  of  one  who  had  the  whole  world  at  his  feet, 
and  yet  contributed  little  or  notliing  which  has  been  of 
essential  importance.  In  fact,  his  peculiar  views  have  been 
so  universally  given  up  that  they  are  of  only  meagre  his- 
toric interest.     He  looked  upon  disease  as  a  condition  in 


stahl's  pietistic  system.  195 

which  bodily  action  or  natural  activities,  being  disturbed 
or  unsettled,  could  take  place  only  with  difficulty ;  the  re- 
verse of  this,  of  course,  constituted  good  health.  Fever  he 
regarded  as  an  effort  of  Nature  to  ward  off  death.  Diges- 
tion was  explained,  like  the  circulation,  upon  mechanical 
principles.  In  his  therapeutics,  besides  his  efforts  to  sweeten 
the  acid,  to  purify  the  stomach,  to  get  rid  of  acridities,  he 
made  Hippocrates  and  Sydenham  his  models.  His  biog- 
rapliers  say  that  his  medicines  were  less  effective  than  his 
personal  appearance.  He  left  many  adherents,  but  no 
school  of  followers.  It  must  be  said,  however,  to  his 
credit,  that,  while  not  the  first  to  give  clinical  instruction, 
he  permanently  established  a  clinical  method  in  teaching. 

Gaub  (1705-1780),  professor  hi  Leyden  from  1731, 
was  but  little  inferior  to  his  master,  Boerhaave,  in  fame  as 
a  teacher.  He  wrote  the  first  complete  work  on  the  ex- 
clusive subject  of  general  pathology.  In  general  thera- 
peutics he  considered  the  healing  power  of  Nature  amply 
sufficient  to  remove  sickness,  but  attributed  this  power 
sometimes  to  the  soul  and  sometimes  to  the  body. 

There  arose,  naturally,  strenuous  opposition  to  the 
views  and  teachings  of  Boerhaave,  and  his  principal  oppo- 
nent was  Stahl  (1660-1734),  who  was  one  of  the  most  im- 
portant systematists  of  any  age,  a  profound  thinker,  and  a 
pioneer  chemist.  He  began  lecturing  in  Jena  at  once 
upon  his  graduation,  at  the  age  of  twenty-five,  and  moved 
through  two  or  three  different  university  positions  until  he 
came  to  Berlin  at  the  age  of  fifty-six.  He  was  a  great 
pietist,  of  uncouth  manners,  faithful  to  his  laboriously  ac- 
quired convictions,  and  bitter  and  relentless  against  those 
who  could  not  accept  them.  Indeed,  he  regarded  his  con- 
victions as  revelations  from  God.  He  looked  upon  the 
success  of  another  as  a  personal  injury  to  himself,  and 
from  being  first  a  croaker  he  became  finally  a  confirmed 
misanthrope,  until  he  fell  into  actual  melancholia.  Pecu- 
niary   profit    he   had    never   sought,   and   its   pursuit   he 


196  THE    HISTORY    OF    MEDICINE. 

scorned.  His  views  were  dynamico-orgaiiic,  pietistic,  and 
antagonistic.  He  regarded  the  soul  as  the  supreme  prin- 
ciple, life-giving  and  life-preserving,  not  to  be  confounded 
with  the  spirit ;  when  hindered  or  obstructed  in  its  opera- 
tion, disease  was  present.  The  soul  governed  the  organism 
cliiefly  by  way  of  the  circulation ;  consequently,  plethora 
played  an  important  role.  To  get  rid  of  this  plethora  the 
soul  employed  either  fever  or  convulsive  movements;  for 
example,  in  children  pletliora  produces  a  pressure  of  blood 
to  the  head,  and,  by  way  of  compensation,  the  soul  provides 
a  haemorrhage  from  the  nose.  For  reasons  easily  appre- 
ciated, he  regarded  bleeding  piles  as  safety-valves  of  the 
utmost  importance.  Fever  was  a  salutary  effort  of  the 
soul  to  preserve  the  body ;  this  was  true  even  of  intermit- 
tents,  and,  accordingly,  he  never  gave  cinchona.  He 
scorned  anatomy  and  physiology,  saying,  in  one  place,  that 
medicine  had  profited  as  much  by  the  knowledge  of  the 
bones  in  the  ear  as  by  a  knowledge  of  snow  which  had 
fallen  ten  years  previously.  But  Stalil  was  one  of  the  most 
eminent  chemists  of  the  age,  and  did  a  great  deal  to 
liberate  chemistry  from  the  glamour  of  alchemy  and  the 
domination  of  pharmacy,  and  to  transform  it  into  an 
independent  science. 

Stahl's  doctrine  has  been  called  animism,  and  was  a 
reaction  against  the  chemical  and  mechanical  theories  of 
the  seventeenth  century.  He  gained  a  considerable  num- 
ber of  followers,  the  most  notable  of  them  among  the 
French  being  Sauvages  (1706-1767),  the  forerunner  of 
Pinel  and  an  opponent  of  pure  mechanics,  who  animated 
the  mechanical  system  of  the  body  with  Stahl's  "soul." 
This  was,  par  excellence,  the  age  of  artificial  systems,  and 
so  Sauvages  in  his  classification  supplied  a  system  which 
had  ten  classes  of  diseases,  each  of  which  had  several 
orders,  and  some  as  many  as  two  hundred  and  ninety-five 
genera,  and  two  thousand  four  hundred  species  of  disease  !! 
Even  Linnaeus  had  three  hundred  and  twenty-five  genera 


HOFFMANN  S    DYNAMIC    SYSTEM.  197 

of  disease,  while   CuUeii  had  only  four  classes  with  one 
hundred  and  forty-nine  genera. 

The  mechanico-dynamic  system  was  a  sort  of  com- 
promise or  mixed  system,  which  was  held  in  high  honor 
by  the  most  eminent  physicians  and  better  minds  of  the 
last  century,  and  has  even  been  prized  by  Sprengel  as  the 
best  of  all.  It  was  originated  by  Friedrich  Hoffmann 
(1660-1742).  Hoffmann's  father  was  a  physician,  and  he 
was  himself  born  in  Halle,  whose  university  he  attended. 
He  acquired  lasting  reputation  as  an  oculist,  and  was  made 
Professor  of  Anatomy,  Surgery,  Medicine,  Physics,  and 
Chemistry  at  his  aJma  mater.  Our  commonplace  "  Hoff- 
mann's anodyne "  is  named  after  him.  He  was  one  of 
the  most  erudite  professors  of  his  day,  more  easily  under- 
stood than  Stahl,  widely  known  for  his  fluent  diction  and 
amiable  temper,  and,  accordingly,  won  great  renown  for 
his  university.  His  good  fortune  as  a  practitioner  was  so 
great  that  even  Boerhaave  declared  him  his  own  equal. 
As  a  writer  he  was  voluminous,  one  edition  of  his  works 
comprising  twenty-seven  large  volumes. 

According  to  Hoffmann's  views,  life  was  simply  me- 
chanical movement,  especially  of  the  heart ;  death,  the 
cessation  of  heart-action,  putrefaction  thereupon  resulting. 
Health  meant  regularity  of  movements ;  disease,  a  disturb- 
ance of  the  same.  He  used  the  word  "  tonus "  exten- 
sively. Ether  he  regarded  as  an  important  factor,  pro- 
ducing and  maintaining  movements  of  the  body,  itself 
extremely  volatile,  corresponding  largely  to  the  "pneuma" 
of  the  ancients  ;  it  was,  in  fact,  a  motor  principle  and,  at 
the  same  time,  the  perceptive  soul.  Ether  was  stored  in 
the  medulla,  and  circulated  in  a  double  way  in  the  body ; 
spasm  was  the  consequence  of  too  strong,  atony  of  too 
feeble,  influx  of  ether.  Fever  was  a  general  spasm  of  the 
arteries  and  veins,  having  its  cause  in  the  spinal  cord. 
Hoffmann's  therapeutics  were  simple,  and  poor  in  drugs. 
These  latter  were  intended  to  weaken,  alter,  or  evacuate, 


198  THE    HISTORY   OF    MEDICINE. 

and  he  was  especially  partial  to  the  use  of  vinous  remedies. 
The  strong  and  toxic  drugs  he  used  hut  little. 

William  CuUen  (1712-1790),  a  Scotchman,  rose  from 
the  deepest  poverty  to  the  greatest  celebrity.  First  a 
barber,  he  afterward  became  an  apothecary,  then  a  ship- 
surgeon,  then  a  village  practitioner,  finally  entering  into 
partnership  with  William  Hunter  as  a  general  practitioner. 
Both  of  these  eminent  men  being  in  equally  poor  circum- 
stances, tliey  agreed  to  live  in  the  same  place  and  that, 
while  one  was  studying,  the  other  should  take  care  of  the 
practice.  In  this  way  Cullen  was  enabled  to  graduate  in 
1740.  Six  years  later  he  tauglit  chemistry  in  Glasgow, 
and  in  ten  years  more  came  to  Edinburgh  as  Professor  of 
Medicine.  He  continued  very  active  and  famous  up  to  the 
time  of  his  death,  but  died  as  he  had  been  born, — in  pov- 
erty. Among  his  numerous  other  charitable  deeds,  he 
was  most  kind  to  the  family  of  Robert  Burns  and  published 
the  latter's  poems. 

Cullen  was  the  father  of  modern  Solidism, — a  system 
based  upon  the  solid  parts  of  the  body,  the  nerves  being 
the  chief  agents.  The  life-giving  element  was,  in  his 
view,  an  undefined,  dynamic  something  (different  from 
Hoffmann's  ether  or  Stahl's  soul),  which  he  called  nerve- 
force^  or  nerve^principh  ;  animdl  force  ;  and  bram-energy, 
and  in  it  he  included  the  spinal  cord.  His  nerve-prin- 
ciple was  supposed  to  produce  spasms  and  atony,  either 
actively  or  passively.  The  causes  of  disease,  while  of  a 
debilitating  character,  were  supposed  to  awaken  reaction 
of  the  healing  powers  of  Nature ;  fever  was  a  reparative 
effort  of  Nature,  even  in  its  cold  stage,  the  blood  playing 
no  part  in  it.  He  constructed  a  very  arbitrary  classifica- 
tion of  fevers,  as,  in  fact,  he  did  of  all  diseases,  his  system 
of  nosology  being  the  secret  of  his  reputation.  His  ex- 
planation of  gout  was  famous.  That  disorder,  he  said, 
depended  upon  an  atony  in  the  digestive  organs  against 
which  was  periodically  set  up  a  reparative  effort  in  form 


VAN    SWIETEN    AND    THE    OLD    VIENNA    SCHOOL.  199 

of  a  joint  inflammation.  In  scrofula  he  had  to  assume,  in 
contradiction  to  his  nervous  pathology,  a  peculiar  acridity, 
and  in  putrid  fever  a  putridity  of  the  humors  of  the  body. 
His  therapeutics  were  simple  and  salutary,  because  of  his 
renunciation  of  venesection,  which  was  much  abused  in 
his  days 

The  most  celebrated  pupils  and  successors  of  Hoffmann 
were  Gregory,  of  Edinburgh,  Gardiner,  and,  in  Germany, 
the  famous  Thaer  (1752-1828),  who  finally  abandoned 
the  practice  of  medicine  because  it  promised  more  than  it 
could  perform,  and  who  became  a  "  father  of  husbandry." 

A  composite  of  the  doctrine  of  Hippocrates,  Sydenham, 
and  Boerhaave  was  represented  in  tlie  so-called  Old  Vienna 
School,  whose  connection  with  the  lives  of  Maria  Theresa 
and  Joseph  II  deserves,  at  least,  mention.  Its  founder  was 
Baron  Van  Swieten  (1700-1772),  of  Leyden,  a  descendant 
of  a  noble  Jansenist  family  of  the  Netherlands,  who  gradu- 
ated under  Boerhaave  after  having  studied  at  Louvain. 
After  the  death  of  his  patron  he  was  called  to  the  assist- 
ance of  the  Archduchess  Maria  Anna,  of  Austria,  who  was 
suffering  from  an  abortion,  and  gave  such  satisfaction  that 
she  recommended  him  to  her  sister,  Maria  Theresa,  who  up 
to  this  time  had  remained  sterile.  To  her  and  to  her  hus- 
band he  gave  advice  which  resulted  in  sixteen  successive 
pregnancies,  and  then,  as  the  result  of  his  success,  came  to 
Vienna  in  1745  as  President  of  the  General  Medical  De- 
partment of  Austria.  He  was  also  made  censor,  in  which 
position  he  incurred  the  enmity  especially  of  the  Jesuits 
and  of  Voltaire,  whom  he  robbed  of  their  influence.  He 
was  made  baron,  and  became,  next  to  Kaunitz,  the  most 
influential  counselor  of  the  empress.  His  chief  care  was 
dedicated  to  the  elevation  of  medical  affairs  in  Austria, 
and  especially  to  the  improvement  of  the  medical  faculty. 
He  had  just  seen  success  crown  his  eff'orts  when  he  died  of 
senile  gangrene,  with  the  reputation  of  being  a  great  phy- 
sician and  benefactor  of  the  poor.     One  of  the  greatest  of 


200  THE   HISTORY    OF    MEDICINE. 

his  services  was  improving  the  treatment  of  syphilis,  in 
which  he,  after  tlie  example  of  Paracelsus,  recommended 
the  internal  use  of  corrosive  sublimate. 

More  eminent  as  a  physician  than  for  personal  char- 
acter was  de  Haen  (1704-1776),  of  The  Hague, — a  pupil 
of  Boerhaave.  At  the  suggestion  of  Van  Swieten,  he  was 
called,  in  1754,  to  Vienna  as  president  of  the  clinic  of  the 
city  hospital,  which  at  that  time  afforded  accommodation 
for  only  twelve  patients.  He  was  the  real  founder  of  tlie 
so-called  Old  Vienna  School,  whose  merit,  in  contrast  to 
the  so-called  new  scliool,  is  to  be  sought  in  practical  and 
diagnostic  services.  As  de  Haen  quarreled  with  every 
one,  he  also  did  with  Stoerck  (1749-1803),  the  successor 
of  Van  Swieten  in  the  direction  of  the  Austrian  Medical 
Department,  and  with  Stoll  (1742-1787), — a  clinical 
teacher  who  was  especially  famous  as  an  epidemiologist. 

Stoll  lectured  with  great  popularity  until  1784,  upon 
the  completion  of  the  Allgemeines  Krankenhaus,  when  he 
fell  into  the  background  and  was  -badly  treated.  He  was 
the  subject  of  numerous  intrigues  by  his  enemies,  and  had 
a  wife  who  embittered  his  life,  and  who  even  had  him 
buried  in  the  dress  of  a  Jesuit  in  order  to  injure  his  repu- 
tation after  his  death. '  To  his  credit  be  it  said  that, 
changing  his  views  of  the  constituents  of  disease  later  in 
life  and  his  original  therapeutics  becoming  no  longer  of 
use  to  him,  he  abandoned  them  entirely.  Nevertheless 
his  therapeutic  system  flourished  for  a  long  time  after  him. 

There  were  in  vogue  during  this  period  numerous  other 
doctrines,  some  of  wliich  were  too  puerile  or  insubstantial 
to  gain  any  foothold  at  all ;  others  exerted  a  certain  amount 
of  influence  during  the  life-time  of  their  originators  or  for  a 
generation  afterward.  With  many  of  these  I  do  not  care 
in  any  way  to  deal.  A  few  others,  I  think,  ouglit  to  be  at 
least  mentioned  in  such  a  history  as  I  am  endeavoring  to 
present. 

There   was  another   Hofl'mann — Christopher    Ludwig 


THE    DOCTRINE    OF    INFARCTUS.  201 

HofFmann  (1721-1807),  of  Westphalia,  who  devised  a  so- 
called  humoral  theory  in  which  the  "acridities"  of  Boer- 
haave  were  mingled  with  the  "putridities"  of  the  pneu- 
matists  and  the  "  irritability  "  of  Glisson.  His  treatment 
and  remedies  for  diseases  were  supposed  to  be  antiseptic, 
as  was  very  proper  when  dealing  with  putridities. 

The  theory  known  as  the  "  Doctrine  of  Infarctus"  had 
its  origin  with  Kampf,  who  died  in  1753.  By  infarctus 
Kampf  understood  impacted  faeces,  which  he  thought 
originated  in  the  humors  of  the  body,  portal  vessels,  and 
intestines  ;  he  recognized  two  kinds, — the  black  bilious  and 
the  mucous.  From  this  tlieory  a  wide-spread  clyster  fashion 
developed,  and  lords  and  ladies  vied  with  each  other  in 
belaboring  their  infarct!  and  in  administering  enemas.  As 
Baas  says :  "  We  cannot  deny  to  the  author  of  this  doctrine 
at  least  an  extensive  knowledge  of  human  nature.  He 
supplied  a  universal  remedial  procedure,  and  gratified  the 
apothecaries  with  the  bulkiness  of  the  herbs  required  for 
its  practice." 

Quite  antagonistic  to  the  views  of  the  Vienna  School 
were  those  of  the  School  of  Montpellier,  inaugurated  by 
Bordeu  (1732-1796),  and  generally  known  as  vitalism. 
Bordeu  died  in  the  enjoyment  of  great  reputation,  but  at 
variance  with  all  his  colleagues.  He  maintained  the 
existence  of  a  general  life  of  the  body, — a  composite  life, — 
resulting  from  the  harmonious  working  of  the  individual 
lives  and  powers  of  all  the  organs,  which  were  supposed  to 
be  associated  with  each  other,  but  each  for  its  own  definite 
function ;  the  most  important  organs — the  stomach,  heart, 
and  brain — being  called  "  the  tripod  of  life."  In  pathology 
he  laid  great  weight  upon  crises,  which  were  supposed  to 
proceed  from  the  glands. 

The  most  important  representative  of  vitalism  was 
Barthez  (1734-1806),  of  Montpellier,— a  man  of  great  gifts 
and  eager  for  knowledge.  He  recognized  a  vital  principle 
as  the  cause  of  the  phenomena  of  life,  but  acknowledged 

COLLuv.  ^l^t^ 


202  THE    HISTORY    OF    MEDICINE. 

that  its  nature  was  unknown,  although  he  endowed  it  with 
motion  and  sensibihty  different  from  a  tliinking  mind. 
Plants  were  supposed  to  possess  it  likewise.  Disease,  he 
believed,  was  the  result  of  an  affection  of  this  vital  principle. 
Every  disease  was  divisible  into  certain  disease-elements, 
viewed  as  parts  of  the  whole,  and  tliese  were  again  divisible 
into  secondary  elements.  He  explained  putrid  fevers  as 
specific  vital  diseases, — in  which  view,  of  course,  he  em- 
bodied humoral  ideas. 

In  Germany,  at  about  this  time,  a  similar  doctrine 
obtained, — a  doctrine  of  vital  forces, — which  the  versatile 
Reil  (1759-1813)  elaborated  into  a  system. 

Meantime,  in  England,  a  doctrine  was  elaborated  by 
Erasmus  Darwin  (1731-1802)  which  partook,  in  a  certain 
degree,  of  the  doctrines  of  Stahl,  Hoffmann,  Haller,  Brown, 
and  Borden.  Erasmus  Darwin  distinguished  himself,  not 
only  as  a  physician,  but  as  a  poet,  philosopher,  and  physi- 
ologist. He  was  a  friend  of  James  Watt.  Of  his  life  it 
is  said  that  by  his  practice  and  very  fortunate  marriages  he 
became  wealthy,  ate  much,  and  drank  nothing  but  water. 
His  chief  work — entitled  Zoonomia^  or  the  Laws  of  Or- 
ganic Life — was  published  in  1784,  and  is  well  worthy  of 
perusal  to-day.  He  recognized  two  fundamental  substances 
— spirit  and  matter.  But  it  is  not  so  much  for  his  doctrine 
as  for  his  researches  into  animal  and  plant  physiology,  and, 
reflexly,  because  of  his  more  celebrated  descendant  of  the 
same  name,  that  we  owe  him  most  gratitude. 


CHAPTER  VIII. 

Age  of  Renovatiox  (continued). — Animal  Magnetism :  Mesmer,  1754-1815. 
Braid. — Brunonianism  :  John  Brown,  _173o-1788. — Realism :  Piuel,  1745- 
1826.  Bichat,  1771-1802.  Auenbrugg'er,  1722-1809.  Werlhof,  1699-1767. 
Frank,  172'y-180i  .—Surgery :  Petit,  1674-1750.  Desault,  1744-1795. 
Scarpa,  1772-1832.  Gimbernat,  f  1'790.  Heister,  1683-1758.  Von  Sie- 
bold,  1736-1807.  Richter,  1742-1812.  Cheselden,  1688-1752.  Monro 
(1st),  1697-1767.  Pott,  1749-1787.  John  Hunter,  1728-1793.  B.  Bell, 
1 1806  ;  J.  Bell,  f  1820  ;  C.  Bell,  f  1842.  Smellie,  1680.  Denman,  1753- 
\S\5.— Revival  of  Experimental  Study :  Haller,  1708-1777.  Winslow,  1669- 
1760.  Portal,  1742-1832.  Vicq  d'Azyr,  1748-1794.  Morgagni,  1682- 
1772. — Inoculation  against  Small-pox :  Lady  Montagu,  t  1762.  Edward 
Jenner,  1749-1823. 

During  the  eigliteenth  century  also  arose  tlie  illusory 
doctrine  of  Animal  Magnetism,  wbicli  obtained  among  all 
classes  a  following  that  can  be  accounted  for  only  by  the 
attractiveness  of  the  marvelous  and  unexplained.  Frank 
Mesmer,  born  near  Lake  Constance,  in  1754,  was  early  a 
victim  of  romantic  yearnings,  and  his  graduating  thesis, 
delivered  in  Vienna,  dealt  with  the  influence  of  the  planets 
upon  man  and  the  use  of  the  magnet.  After  traveling 
extensively  he  erected  a  private  institution,  where  he 
treated  blind  girls,  fidgety  old  maids,  and  simpletons,  until 
his  deceptive  methods  were  unmasked  by  a  commission 
appointed  by  the  Empress  Maria  Theresa,  and  he  was  com- 
pelled to  leave  Vienna  in  twenty-four  hours.  This  mar- 
tyrdom recommended  him  in  Paris,  where  the  so-called 
Mesmerism  speedily  became  fasliionable.  Pie  finally  under- 
took instructions  in  magnetizing,  at  the  rate  of  100  louis  a 
head,  and  founded  the  "  Order  of  Harmony."  His  so-called 
haquets  were  tubs  witli  magnetic  ducts,  partially  filled  with 
soft  water  and  all  kinds  of  ingredients,  and  armed  with 
iron  conductors,  with  which  his  pupils,  joining  hands,  placed 
themselves  in  contact.  At  these  seances  Mesmer  appeared 
in  lilac-colored  clotlies  and  professed  to  reinforce  the  action 
of  the  tubs  by  looks,  gestures,  playing  upon  the  harmonica, 
and  touching  the  subjects  with  wand  or  fingers.     "  If  any 

(203) 


204  THE    HISTORY    OF    MEDICINE. 

one,  particularly  a  lady,  had  a  crisis  at  this  time,  she  was 
borne  to  the  'crisis-chamber'  by  Mesmer  himself,  where  he 
treated  her  alone,  as  only  when  alone,  he  claimed,  could 
he  attain  success."  He  speedily  became  wealthy;  man- 
aged to  deceive  even  the  Queen  of  France ;  and,  when  he 
threatened  to  deprive  the  country  of  his  presence,  20,000 
francs  were  offered  him  to  instruct  others  in  his  art.  This 
offer,  however,  the  wily  charlatan  declined.  In  1785  some 
fool  penned  an  article  extolling  him  as  a  worker  of  mira- 
cles ;  this  stimulated  the  authorities  to  organize  a  com- 
mittee of  investigation,  the  adverse  decision  of  which, 
along  with  some  contributory  evidence,  made  Paris  too 
warm  for  him.  After  the  revolution  he  returned,  but  his 
day  had  passed,  and  he  figures  no  more  in  medical  history. 
He  has  had  many  imitators,  and  the  mesmeric  craze, 
at  times,  has  infested  different  portions  of  the  civilized 
globe ;  even  some  who  were  eminent  in  science  have  fallen 
into  the  snares  of  so-called  Mesmerism, — notably  Olbers, 
the  discoverer  of  a  number  of  asteroids.  Mystic  medical 
doctrines,  founded  upon  Mesmer's  views,  still  continue  in 
certain  circles,  though  the  majority  have  long  since  suc- 
cumbed to  the  advances  of-scientific  psychology.  In  this 
connection  it  is  proper  to  speak  of  the  revived  interest  in 
"  animal  magnetism  "  due  to  the  researches  of  Dr.  James 
Braid,  of  Manchester,  England.  Tliis  gentleman,  in  1842, 
published  a  work  which  pretty  thoroughly  exposed  the 
fallacies  of  the  doctrine  of  Mesmer,  and  expoimded  many 
of  the  truths  that  were  entangled  therein.  He  was  among 
the  first,  perhaps,  to  employ  the  phrase  "  animal  magnet- 
ism," and  was  the  author  of  the  term  "  hypnotism,"  though 
in  his  day  the  popular  title  was  Braidism. 

During  the  middle  of  the  eighteenth  century  arose  a 
doctrine  that,  in  its  novelty,  ease  of  practical  application, 
and  apparent  consistency  (through  the  ingenious  employ- 
ment of  certain  vital  phenomena),  secured  such  a  hold  that 
its  influence  continued  even  into  the  present  century.    This 


JOHN    BROWN.  205 

was  the  "Brunonian  doctrine,"  promulgated  and  upheld  by 
tlie  great  foe  and  rival  of  Cullen, — Doctor  John  Brown. 
In  youth  very  precocious,  though  of  most  humble  birth, 
Doctor  Brown  had  mastered  the  Latin  language  at  the 
early  age  of  seven  years,  and  three  years  later  essayed  to 
learn  a  trade.  At  the  age  of  twenty  he  left  his  native 
village  of  Dunse  for  Edinburgh,  seeking  employment  as  a 
tutor  and  intending  to  study  theology.     Poverty  soon  com- 


FiG.  29.— John  Brown,  M.D. 

(From  a  steel  engraving  by  J.  Caldwell  of  a  miniature  painted  by  Donaldson.) 

pelled  him,  however,  to  take  a  rural  school,  but  he  returned 
a  few  years  later  (in  1759)  to  the  Scottish  Athens  and 
began  the  study  of  medicine,  supporting  himself  meantime 
by  rendering  theses  into  Latin  and  by  teaching,  translating, 
and  quizzing.  Finally,  he  attracted  the  attention  of  Cul- 
len, to  whom  he  became  useful  through  his  knowledge  of 
the  classics ;  but,  ultimately,  a  foolish  quarrel  made  bitter 
enemies  of  the  former  friends.     In  1770,  in  private  lect- 


206  THE    HISTORY    OF    MEDICINE. 

ures,  Brown  began  to  advance  the  theory  to  which  he  had 
been  led  by  one  of  liis  own  attacks  of  gout  that  disap- 
peared under  the  use  of  stimulants,  the  disease  having 
previously  always  been  aggravated  by  the  treatment  pre- 
scribed and  that  was  held  to  be  orthodox, — viz.,  anti- 
phlogistic. He  had  now  become  somewhat  dissolute,  and 
the  students  he  gathered  about  him  were  of  very  much  the 
same  character ;  but  they  formed  the  nidus  of  a  great  fol- 
lowing opposed  to  Cullen,  and  quarreled  on  all  occasions 
with  the  adherents  of  the  latter.  .  Finally,  Doctor  Brown 
removed  to  London,  where  fortune  seemed  to  smile  upon 
him,  as  he  gained  rapidly  in  reputation  and  practice;  in- 
deed, he  barely  missed  a  call  to  Berlin  and  another  to 
Padua  as  a  teacher,  the  scale  being  turned  against  him  by 
his  dissolute  habits.  Though  possessed  of  the  highest 
mental  gifts,  Brown  was  unfortunate  in  lack  of  mental 
stamina.  He  taught  that  life  is  not  a  natural  condition, 
but  an  artificial  and  necessary  result  of  constant  irritations; 
all  living  beings,  therefore,  tend  toward  death.  Health  is 
an  intermediate  grade  of  excitement ;  diseases,  which  are 
either  sthenic  or  asthenic,  represent  either  too  high  or  too 
low  a  grade  of  excitement.  It  has  been  said  that  Brown's 
teachings  slaughtered  more  human  beings  than  the  French 
Revolution  and  the  wars  of  Napoleon  combined.  In 
England  this  system  found  no  important  followers,  but  in 
America  Benjamin  Hush,  of  Philadelphia  (1745-1815), 
distinguished  himself  as  an  adlierent.  In  Spain  and 
France  it  found  little  place ;  but  in  Italy,  and  later  in  Ger- 
many, it  secured  a  numerous  and  important  following, 
which  numbered,  among  others,  Scarpa,  Massini,  and 
Girtanner. 

Another  system  which  attained  influential  development, 
extending  even  into  the  present  century,  was  the  so-called 
Realism^  originated  by  Pinel  (1745-1836).  Born  in  pov- 
erty, and  designed  for  the  Roman  Catholic  Church,  Pinel 
did  not  turn   his  attention  to  medicine  until  his  thirtieth 


pinel's  labors  among  the  insane.  207 

year,  but  on  completing  his  studies  he  rapidly  rose  to 
positions  of  importance.  Led  to  the  investigation  of 
mental  diseases  by  the  fate  of  one  of  his  particular  friends, 
who  had  become  insane,  escaped  into  the  forest,  and  was 
there  devoured  by  wolves,  Pinel  speedily  developed  a  great 
interest  in  this  class  of  sufferers.  The  lot  of  the  insane  at 
this  time  was  most  pitiable  :  they  were  imprisoned,  chained, 
and  treated  worse  than  wild  beasts.     In  his  efforts  to  im- 


FiG.  30.— Ph.  Pinel. 

(From  an  old  lithograph  of  tlie  eighteenth  century.) 


prove  their  lot,  Pinel  acquired  the  title  of  conservative  and 
aristocrat,  either  of  which  was  almost  equivalent  to  a  death- 
sentence.  Unterrified,  however,  he  appeared  before  the 
Paris  Council  and  urged  the  adoption  of  reformatory 
measures,  replying  to  the  challenges  of  skeptical  and  self- 
regardful  opponents  by  liberating  a  number  of  insane  pa- 
tients who  were  in  his  charge.  The  courage  thus  exhibited 
receives  appreciation  in  our  time,  if  never  before.     Not  the 


208  THE   HISTORY    OF   MEDICINE. 

least  of  Pinel's  services  was  the  substitution  of  analytical 
for  synthetical  methods;  he  also  sought  to  determine  dis- 
ease by  a  diagnosis  carefully  constructed  from  symptoms, 
but  unfortunately  he  made  pathology  and  anatomy  sub- 
ordinate factors.  He  was  a  pupil  of  Barthez,  but  he 
placed  his  preceptor's  vitalism  far  in  the  background. 

Francois  Bicliat,  born  in  1771,  earned  high  rank  both 
as  a  clinician  and  an  anatomist.  His  education  was  begun 
in  Nantes,  but  he  studied  surgery  and  anatomy  in  Lyons 
and  Montpellier,  subsequently  going  to  Paris,  where  he 
became  a  member  of  Desault's  family.  After  the  death 
of  his  patron  he  lectured  on  surgery,  and  from  1797  on 
anatomy.  Possessed  of  a  feverish  scientific  activity,  he 
became  a  member  of  the  Societe  d'Emulation.  Death 
overtook  him  in  1802  as  the  sequel  of  consumption  and  an 
injury  received  through  a  fall.  He  was  the  most  capable 
physician  of  France  in  his  time,  and,  brief  as  was  his  span 
of  life,  he  was  author  of  nine  important  volumes,  the  chief 
of  which  were  a  Treatise  on  Membranes  and  works  on 
general  and  pathological  anatomy.  From  the  latter  a  new 
tendency  in  study  took  origin.  He  it  was  who  gave  utter- 
ance to  the  aphorism :  "  Take  away  some  fevers  and 
nervous  troubles,  and  all  else  falls  to  the  kingdom  of  path- 
ological anatomy."  As  an  evidence  of  his  energy,  it  is 
related  that  he  in  one  winter  examined  seven  hundred 
bodies.  He  taught  how  to  discriminate  between  disease 
processes,  and  notably  subdivided  peripneumonia  into  pleu- 
risy, pneumonia,  and  bronchitis,  these  having  been  pre- 
viously confounded.  He  once  remarked ;  "  You  may 
observe  disease  of  the  heart,  lungs,  abdominal  viscera,  etc., 
night  and  morning  by  the  sick-bed  for  twenty  years,  yet 
the  whole  furnishes  merely  a  jumble  of  phenomena  which 
unite  in  nothing  complete ;  but  if  you  open  a  few  bodies, 
you  will  see  the  obscurity  speedily  give  way, — a  result  never 
accomplished  by  observation  if  we  do  not  know  the  seat  of 
the  disease."    To  Bichat  is  also  due  our  modern  recognition 


BICHAT.  209 

of  cellular,  osseous,  fibrous,  and  other  tissues,  as  such, 
wherever  they  appear  throughout  the  body.  He  differ- 
entiated, without  the  aid  of  the  microscope,  twenty-one 
different  tissues  as  simple  and  similar  elements  of  the  body, 
enumerating  them  as  one  does  the  chemical  elements ;  he 
described  the  stomach  as  composed  of  mucous,  serous,  and 
muscular  layers ;  overthrew  the  speculative  tendency  of 
medicine,  and   placed    facts   in  the   front   rank;   and   so 


Fio.  31.— Marie  Francois  Xavier  Bichat,  M.D. 
(From  a  steel  engraving  by  H.  Cooke  of  a  painting  by  Vigneron.) 

conspicuous  were  his  services  that  he  has  been  termed 
the  "  Napoleon  of  Medicine."  He  supplemented  the  in- 
fluence of  Pinel  upon  the  side  of  pathological  anatomy ; 
called  sensibility  and  contractility  vital  properties,  whose 
alterations  constitute  disease,  claiming,  however,  that 
the  vital  properties  of  individual  tissues  differed  among 
themselves.  His  life  and  works  are  revelations  to  young 
men,  and  show  what  can  be  accomplished  at  a  very  early 

14 


210  THE    HISTORY    OF    MEDICINE. 

age  by  sufficiently  active  and  harmoniously  developed 
brains. 

In  reviewing  the  theories  and  lives  of  those  mentioned 
as  medical  luminaries  of  the  eighteenth  century,  one  ex- 
periences a  feeling  of  mingled  respect  and  disappointment 
— respect  for  the  devoted  way  in  which  tliey  worked  and 
souglit  for  the  truth,  and  disappointment  at  so  much  waste 
of  intellectual  power  and  labor.  The  lesson  is  also  taught, 
and  sliould  be  impressed,  that  in  all  so-called  new  systems 
old  principles  for  the  most  part  reappear,  and  that  tlie 
labors  of  the  past  are  rarely  so  deliberately  consulted  as  to 
guard  against  repetition  and  revamping  of  theories  that  had 
long  before  been  proved  futile. 

Let  me  now  mention  a  few  other  of  the  physicians  of 
the  last  century  who  have  left  more  or  less  of  an  impress 
upon  their  successors  and  upon  our  science.  One  man,  in 
particular,  historians  are  wont  to  remember  with  the  honor 
that  was  denied  him  by  liis  colleagues  and  contemporaries. 
I  refer  to  Leopold  x\uenbrugger,  who  was  born  in  Graz  in 
1722,  and  who,  after  pursmng  his  philosophical  and  pro- 
fessional studies  in  his  native  city,  obtained,  at  the  age  of 
twenty-nine,  charge  of  a  Spanish  military  hospital ;  while 
thus  employed  he  invented  tlie  art  of  percussion  as  applied 
to  diagnosis.  This  he  gave  the  test  of  experience  during 
seven  long  years  before  making  it  known  to  the  profession, 
and  even  then  it  was  not  appreciated,  but  remained  prac- 
tically unnoticed  until  after  his  death,  wliich  occurred  in 
1809.  He  did  receive  a  patent  of  nobility  from  the  Em- 
peror Joseph  II,  but  this  hardly  compensated  him  for  the 
contumely  heaped  upon  him  by  his  colleagues.  Paulus 
^Egineta  employed  sounds  and  specula ;  Santoro  used  the 
balance,  counted  the  pulse,  and  resorted  to  the  use  of  the 
thermometer ;  Boerhaave  employed  the  thermometer  and 
the  simple  lens;  Floyer,  and  after  him  Haller,  utilized  the 
watch  in  marking  seconds  ;  a  Salernian  practitioner  utilized 
auscultation  and  percussion  in  tympanites  and  ascites  ;  but 


AUENBRUGGER.  21 1 

the  diagnosis  of  diseases  of  tlie  great  viscera  by  percussion 
was  never  known  before  Auenbruggcr.  His  booklet  of 
twenty-two  pages,  unsalable  in  his  time,  is  to-day  held 
wortli  far  more  than  its  weight  in  gold.  His  famous  col- 
league, de  Haen,  wrote  fifteen  volumes  witliout  a  word  on 
percussion  ;  Van  Swieten  did  it  no  greater  justice ;  in  his 
great  treatise  on  the  History  of  Medicine,  Sprengel  barely 
alludes  to  it ;  yet  the  contents  of  Auenbrugger's  booklet 
were  of  more  practical  value  than  all  that  these  other  men 
ever  wrote,  or  all  the  results  of  the  vast  and  bloody  cam- 
paigns during  which  it  slept.  In  1808  this  volume  was 
rescued  from  oblivion  by  Corvisart,  who  translated  it  into 
French  and  proclaimed  its  undying  value. 

During  the  earlier  part  of  this  century  lived  Werlhof, 
of  Helmstadt  (1699-1767),  a  far-famed  observer,  author, 
and  practitioner,  who  declined  a  professorship,  and  espe- 
cially distinguished  himself  as  a  writer  of  German  poetry. 
Though  possessed  of  an  exceptional  knowledge  of  modern 
tongues,  he  wrote  only  in  Latin,— the  scientific  language 
of  the  day.  In  1734  he  was  appointed  physician  to  King 
George  II,  in  which  position  he  attained  world-wide  fame, 
while  indefatigable  in  his  efforts  to  elevate  science.  He 
first  described  the  disease  known  by  his  name, — morbus 
maculosus  WerUioJii, — and  struggled  hard  to  establish  in 
Germany  the  use  of  cinchona. 

From  1740  to  1802  flourished  Wichman,  of  Hanover, 
highly  esteemed  as  a  writer  and  practitioner.  He  is  espe- 
cially known  for  his  pleas  in  favor  of  more  scientific 
diagnoses,  and  his  demonstration  of  how  to  make  them. 
The  role  of  the  itch-mite  in  the  transmission  of  scabies  he 
demonstrated  upon  himself;  to  be  sure,  Bonomo,  a  hundred 
years  before,  had  called  attention  thereto,  but  with  little 
avail. 

Another  eminent  Hanoverian  was  the  fickle,  stubborn, 
and  misanthropic  Zimmerman,  born  in  1728,  in  Berne, 
upon  whom  misfortune  and  disease  played  many  shabby 


212  THE    HISTORY    OF    MEDICINE. 

tricks.  He  was,  liowever,  a  man  of  ingenious  endow- 
ments, and  merits  especial  regard,  because  he  sought  to 
free  medical  science  from  the  cliarge  of  being  a  secret  art. 

Anotlier  of  the  prodigies  of  medical  history  was  J.  P. 
Frank,  born  (1725)  in  the  Bavarian  Pahitinate,  of  pauper 
parents,  and,  while  an  infant,  abandoned  by  a  cruel  father. 
His  early  life  was  passed  in  a  religious  school;  at  twenty- 
five  he  became  a  court  and  garrison  physician,  and  later 
a  professor  in  Gottingen;  finally  he  went  to  Vienna,  where 
he  died  in  1801.  He  was  greatly  beloved  by  his  pupils, 
and  Walther,  the  famous  surgeon,  said  of  him:  "No  one 
ever  made  so  elevating  and  permanent  an  impression  on 
me."  He  published  an  extensive  work  on  forensic  medicine 
and  sanitation, — wherein  he  took  up  the  hygiene  of  the 
individual,  of  the  family,  and  of  the  school, — which 
constituted  an  effort  far  ahead  of  anything  of  the  kind 
previously  known.  He  is  also  memorable  for  efforts  toward 
increasing  the  population,  for  the  Thirty  Years'  War  had 
depopulated  extensive  districts — to  such  a  degree,  indeed, 
that  in  1750  bigamy  was  legalized  in  Nuremberg  and  many 
other  towns.  Frank  was  distinguished  for  a  keen  and 
even  caustic  humor,  whose  subject  was  not  infrequently 
himself. 

From  1707  to  1782  there  lived  in  England  one  Sir 
John  Pringle,  chief  of  the  Army  Medical  Department, 
known  to  this  day  as  an  author  upon  military  hygiene. 
John  Huxliam  (1794—1868)  advanced  our  knowledge  of 
putrid  dissolution  of  the  blood.  John  Howard  (1766-1790) 
rendered  eminent  service  in  prison  reform.  Heberden 
(1710-1801)  was  the  first  to  describe  varicella,  and  also 
angina  pectoris — which  was  long  known  as  Heberden's 
asthma.  John  Fothergil  (1712-1780),  a  Quaker,  acquired 
fame  by  his  observations  on  chronic  angina,  neuralgia,  and 
hydrocephalus ;  was  likewise  a  benefactor  of  the  poor, 
regarding  them  as  "bridges  to  the  pockets  of  tlie  rich"; 
indeed,  a  large  part  of  what  he  gained  from  the  latter 


FRENCH    SURGEONS   OF    RENOWN.  .  213 

class  he  bestowed  in  charity,  and  at  his  death  left 
i:2()0,000  for  the  same  purpose.  RadcHffe  (1750-1814) 
was  an  eminent,  witty,  successful  practitioner  of  London, 
who  was  wont  to  declare  that,  as  a  young  practitioner, 
he  possessed  twenty  remedies  for  every  disease,  but  at  the 
close  of  his  career  had  found  twenty  diseases  for  which 
he  had  not  one  remedy.  Richard  Mead  (1673-1754) 
was  a  prolific  writer,  and  the  autlior  of  the  first  quar- 
antine regulations  adopted  in  England.  Contemporary 
witli  Mead  was  Lettsom, — the  busiest,  most  philanthropic, 
and  most  successful  physician  of  his  day, — whose  practice, 
although  a  large  part  of  it  was  gratuitous,  brought  him 
sixty  thousand  dollars  a  year,  and  who  gave  away  immense 
sums  for  charitable  purposes;  also,  Thomas  Dover,  who 
invented  the  sedative  known  by  his  name  and  who  died 
in  1741.  Akenside,  physician  and  poet  (1721-1770), 
wrote  on  dysentery.  Baillie,  of  Edinburgh,  was  the  first 
to  accurately  describe  tlie  morbid  anatomy  of  gastric 
ulcer. 

Among  the  French  surgeons  must  be  mentioned  la 
Peyronie,  of  Montpellier,  born  in  1668,  who  ultimately 
became  director  of  the  Academy  of  Surgery  and  surgeon 
to  the  king.  His  wealth  was  employed  for  the  elevation 
of  the  craft,  and  he  founded  no  less  than  ten  different 
surgical  professorships  at  his  own  expense.  In  1743 
he  effected  the  separation  of  the  surgeons  from  the 
barbers.  He  died  in  1747,  dedicating  his  estate  to  the 
purpose  for  which  he  had  lived.  The  most  famous  of  the 
earlier  surgeons  of  this  century  was  J.  L.  Petit  (1674— 
1750),  inventor  of  the  screw  tourniquet,  and  who  was 
called  to  treat  Augustus  the  Strong,  of  Poland ;  indeed, 
several  other  crowned  heads  became  his  patients.  Garen- 
geot  (1688-1759),  a  professor  in  the  College  of  St. 
Come,  published  a  work  on  operative  surgery.  Morand 
(1697-1773)  and  le  Dian  were  distinguished  surgeons 
of  Paris,   the    former    especially    noted    for    the    number 


214  THE    HISTORY    OF    MEDICINE. 

of  times  he  performed  paracentesis.  Famous  litliotomists 
were  le  Cat  and  Frere  Come, — whose  real  name  was 
Baseilhac,  and  who  operated  by  means  of  the  lithotome 
cache.  Astruc  (1685-1766)  was  a  syphilographer  of 
extensive  attainments;  Quesnay  (1694-1774),  an  eminent 
and  undaunted  surgeon  of  Louis  XV,  who  wrote  on  the 
history  and  progress  of  surgery  in  France;  Brasdor  (1721- 
1776)  was  best  known  for  his  method  of  distal  ligation  in 
aneurism;  Sabatier  (1732—1811)  wrote  a  famous  treatise 
on  operations,  in  which  he  recommended  resection  of  the 
head  of  the  humerus. 

One  of  the  most  celebrated  surgeons  was  P.  J.  Desault 
(1744-1795),  the  son  of  a  poor  farmer,  originally  designed 
for  the  priesthood,  but  who,  after  obtahiing  a  thorough 
mathematical  education,  began  the  study  of  surgery  with 
an  ignorant  master  of  his  native  town.  Subsequently  he 
went  to  Paris,  and  here  supported  himself  by  teaching, 
gradually  rising,  step  by  step,  until,  without  collegiate 
education,  he  became  professor  and  chief-surgeon  at  the 
Hotel-Dieu,  where  he  established  the  first  surgical  clinic. 
He  opposed  violently  the  prevalent  abuse  of  the  trephine, 
and  was  also  a  champion  of  healing  by  first  intention.  A 
trusted  friend  of  Desault  was  Chopart,  well  known  because 
of  the  amputation  of  the  foot  that  bears  his  name. 
Another  well-known  surgeon,  likewise  a  friend  of  Desault, 
was  Doublet ;  and  it  is  somewhat  remarkable  that  Desault, 
Chopart,  and  Doublet  suffered  persecution  and  perhaps 
martyrdom  in  connection  with  the  supposed  death  of  the 
Dauphin  of  France, — properly  l^ouis  XVII, — in  1795. 
There  is  evidence  that  the  child  who  died  in  the  temple 
was  not  the  dauphin,  but  a  substitute,  and  tliese  three 
surgeons,  who  examined  the  corpse,  had  the  hardihood  to 
express  their  doubts.  The  same  day  that  Desault  reported 
upon  the  evidence  he  was  invited  to  dinner  by  some  mem- 
bers of  the  Convention,  was  taken  ill  at  the  table,  and 
died  almost  immediately  after  his  return  home.     A  few 


GERMAN  SURGEONS  OF  RENOWN.  215 

days  later  Chopart  and  Doublet  died,  also  under  mysteri- 
ous circumstances. 

Daviel  (1796-1862)  is  remembered  among  French 
surgeons  chiefly  for  extraction  of  the  lens  as  an  inde- 
pendent method  of  treating  cataract;  Tenon  (1T24-1816), 
for  his  writings  on  the  anatomy  and  diseases  of  the  eye ; 
and  Anel  for  originating  tlie  operation  for  aneurism,  mis- 
takenly attributed  to  Hunter.  There  were  also  many 
others,  of  lesser  note,  who  distinguished  themselves 
through  special  services  to  surgery  or  some  of  its 
branches. 

Among  the  Italians  of  this  century  may  be  mentioned 
Scarpa  (1772-1832),  of  Motta,  professor  successively  in 
Modena  and  Pavia,  and  who  advanced  our  knowledge  of 
hernia,  diseases  of  the  eyes,  aneurism,  and  general 
anatomy. 

The  most  famous  Spanish  surgeon  was  Gimbernat,  of 
Madrid  (1742-1790),  for  a  time  professor  in  Barcelona, 
who  also  became  distinguished  through  anatomical  re- 
searches. 

German  surgeons  did  not  rank  high  during  the  earlier 
half  of  the  last  century,  owing  to  the  contempt  engendered 
by  the  church  for  this  branch  of  the  medical  art.  The 
fashion  of  imitating  the  French,  however,  led  to  some  sur- 
gical development.  The  first  German  surgeon  of  scientific 
education  was  Heister  (1683-1758),  of  Frankfort-on-the- 
Main,  who,  unable  to  obtain  honorable  employment  in  the 
military  service  of  liis  own  country,  entered  that  of  Hol- 
land, where  lie  remained  until  the  experience  of  his  own 
nation  had  brought  about  a  healthy  reaction.  In  1720  he 
came  to  Helmstadt,  where  he  developed  great  activity  in 
anatomy,  surgery,  and  botany ;  also  distinguished  himself 
as  a  dentist  and  oculist,  and  discussed  the  whole  range  of 
surgical  topics  from  the  least  to  the  greatest. 

Bilguer  (1720-1796),  of  Chur,  became  surgeon-general 
in  Berlin,  and  performed  the  first  resection  of  the  wrist  in 


216  THE    HISTORY    OF    MEDICINE 

1762;  he  was  an  opponent  of  amputation,  which  at  that 
time  was  altogether  too  frequently  practiced. 

Von  Siebold  (1736-1807)  was  the  founder  of  an  insti- 
tution for  surgical  instruction,  where,  for  the  first  time  in 
Germany,  surgery  was  taught  clinically.  He  became  one 
of  the  most  famous  teachers,  and  was  first  in  his  native 
land  to  perform  the  operation  of  symphysiotomy,  so  recently 
revived 

The  greatest  German  surgeon  of  the  eighteenth  cent- 
ury, however, — one  eminent  both  as  writer  and  operator, 
—was  August  Gottlieb  Kichter  (1742-1812),  of  Zorbig,  a 
descendant  of  a  ministerial  family,  who  wrote  a  famous 
work  on  hernia,  and  greatly  improved  all  branches  of  sur- 
gery ;  he  it  was  that  enunciated  the  principle  of  dressing 
wounds  "  quickly,  easily,  and  rarely." 

Among  English  surgeons  of  the  century  must  be  men- 
tioned, first  of  all,  Cheselden  (1688-1752),  whose  name  is 
inseparably  connected  with  anatomy  and  patliology  as  well 
as  surgery  At  first  a  warm  advocate  of  tlie  liigli  operation 
for  stone,  his  dexterity  in  lithotomy  excited  the  wonder  of 
his  contemporaries.  He  published  a  treatise  on  anatomy, 
and  one  on  the  suprapubic  section. 

Alexander  Monro,  Sr.  (1697-1767),  of  Edinburgh,  was 
also  eminent  in  both  anatomy  and  surgery,  and  contributed 
more  than  any  other  one  man  to  the  success  and  reputation 
of  the  Scottish  medical  schooh  His  sons,  Alexander  and 
Donald,  and  his  grandson,  Alexander  (3d),  were  equally 
celebrated  in  anatomy. 

Charles  White,  of  Manchester,  is  generally  credited 
with  having  performed,  in  1768,  the  first  subperiosteal 
resection  of  the  head  of  the  humerus,  although,  as  a  matter 
of  fact,  this  was  not  done  until  1774,  and  then  by  Bent,  of 
Newcastle.  He  also  performed  resection  of  the  hip-joint 
upon  the  cadaver — another  of  the  same  name,  Anthony 
White,  having  done  the  operation  on  the  living  subject  in 
1721.     He  invented  the  method  of  reducing  dislocation  of 


ENGLISH    SURGEONS   OF   RENOWN.  217 

the  humerus  with  the  foot  in  the  axilla, — a  procedure  that 
is  ordinarily  ascribed  to  Sir  Astley  Cooper ;  also  operations 
for  false  joint  by  the  removal  of  the  involved  surfaces  of 
the  bone. 

It  will  be  seen  that  the  excision  of  the  joints  was 
peculiarly  an  English  method,  the  elbow-joint  having  been 
first  excised  in  1758,  by  Wainman,  and  the  knee-joint  by 


Fig.  32.— "Wii-liam  Hunteb,  M.D.,  F.R.S. 

(From  a  steel  engraving  by  J.  Thomson,  made  from  a  painting  by  Pyne.) 

Filkin,  of  Northwich.  The  man  who  permanently  attracted 
the  attention  of  surgeons  to  these  new  operations  was 
Henry  Park,  a  bold  surgeon,  who  wrote  in  1782.  The 
merits  of  these  methods  were  then  soon  forgotten,  however, 
and  were  revived  in  the  present  century  by  Liston  and 
Syme. 

One  of  the  best-known  London  surgeons  was  Percival 
Pott  (1749-1787),  who  became  especially  eminent  through 


218  THE    HISTORY    OF    MEDICINE. 

his  studies  upon  hernia,  spinal  disease,  and  diseases  of  the 
bones  and  joints ;  his  complete  chirurgical  works  appeared 
in  London  in  1771 

William  Hunter  (1718-1783),  of  Scotch  parentage, 
originally  a  theological  student,  and  a  pupil  of  Cullen, 
went  to  London  in  1741,  began  to  lecture  on  anatomy  and 
surgery  in  1746,  and  soon  acquired  a  great  reputation  as  a 
surgeon,  obstetrician,  and  anatomist.  He  achieved  enor- 
mous success  in  practice,  and  spent  £100,000  upon  his 
house,  library,  and  private  collections.  The  latter  now 
form  the  Hunterian  Museum  in  tlie  University  of  Glasgow. 
His  magnificent  plates  illustrating  the  gravid  uterus  re- 
quired the  labors  of  twenty  years  and  appeared  in  1774. 

John  Hunter  (1728-1793),  younger  brother  of  Will- 
iam, enjoyed  even  greater  reputation  than  the  latter.  He 
was  a  pupil  not  only  of  his  brother,  but  also  of  Cheselden 
and  Pott.  Beginning  the  practice  of  surgery  in  1763, 
he  became  surgeon  to  St.  George's  Hospital  in  1768,  and 
Surgeon-general  of  the  English  forces  in  1790.  So  mem- 
orable were  the  labors  and  services  of  this  man  that  at  the 
Royal  College  of  Surgeons,  of  London,  there  is  given  an- 
nually an  "Hunterian  Oration,"  intended  in  some  way  to 
commemorate  his  labors  or  to  draw  some  lesson  from  his 
life  and  work.  To  do  justice  to  John  Hunter  would  re- 
quire a  volume,  hence  we  must  at  present  dismiss  the 
subject  with  this  brief  reference. 

Almost  equally  famous  as  a  surgeon,  though  by  no 
means  such  an  omnivorous  student  as  Hunter,  was  Ben- 
jamin Bell,  of  Edinburgh,  who  died  in  1806.  He  em- 
ployed tubes  of  lead  and  silver  for  the  purpose  of  drainage. 
Sir  Charles  and  Jolin  Bell,  also  of  Edinburgh,  are  eminent 
names  pertaining  to  tlie  latter  part  of  the  eighteenth  and 
first  part  of  the  nineteenth  century.  The  latter  was  Pro- 
fessor of  Anatomy,  Surgery,  and  Obstetrics,  a  busy  prac- 
titioner, a  fertile  writer,  and  not  only  one  of  the  most 
successful  operators  of  his  day,  but  an  excellent  classical 


JOHN    HUNTER.  219 

scliolar;  his  Principles  of  Surgery  appeared  from  1801 
to  1807.  Sir  Charles,  who  died  in  1842,  belongs  more  to 
the  present  century,  but  was  equally  distinguished  as  an 
operator,  surgeon,  and  writer,  and  best  known,  perhaps, 
for  his  Bridgewater  Treatise  on  the  Hand. 

Among  the  Dutch  an  eminent  surgeon  was  Peter  Cam- 
per (1722-1789),  who,  in  order  to  acquire  manual  dex- 
terity, learned  to  use  various  mechanical  tools.     He  was  a 


Fig.  33.— John  HrNTER. 

(From  .1  steel  engiaving  by  G.  H.  Adcock  of  a  painting  by  Sir  Joshua  Reynolds.) 

fruitful  author,  and  did  not  consider  it  beneath  liis  dignity 
to  write  a  treatise  about  the  best  form  of  shoes,  published 
in  Vienna  in  1782,  but  recently  translated  and  republished 
in  England  as  something  new.  Sandifort,  of  Leyden,  dis- 
cussed ruptures,  dislocations,  etc.,  and  reported  the  first 
observation  of  downward  dislocation  of  the  femur. 

As  already  noted,  the  surgeons  of  the  eighteenth  cent- 
ury were  often  obstetricians, — William   Hunter  conspicu- 


220  THE   HISTORY    OF    MEDICINE. 

ously.  The  most  important  obstetrician  of  bis  time  was 
William  Smellie  (1680-1763),  of  London,  wbo  invented 
numerous  instruments,  wrote  a  large  treatise  on  tbe  tlieory 
and  practice  of  midwifery,  and  greatly  advanced  our  knowl- 
edge of  deformed  pelves.  He  was  tbe  first  to  distinguish 
one  diameter  from  the  other,  and  to  point  out  the  im- 
portance of  cephalic  version  and  version  of  the  breech. 
Parenthetically,  it  may  be  remarked  that  William  Hunter, 
great  as  he  was,  was  the  uncompromising  foe  of  instru- 
mental midwifery,  and  was  in  the  habit  of  showing  his 
forceps,  covered  with  rust,  as  evidence  that  he  never  re- 
sorted to  such  aids.  A  rival  of  Smellie  and  Hunter  was 
Thomas  Den  man  (1753-1815),  best  known,  perhaps,  be- 
cause of  his  demonstration  of  the  portability  of  puerperal 
infection. 

The  researches  of  anatomists  during  the  eighteenth 
century  were,  for  the  most  part,  directed  toward  the  minute, 
more  difficult,  and  less  striking  parts,  and  to  increased 
thoroughness  and  accuracy  of  description.  Microscopical 
anatomy  suffered  a  relative  quiescence.  Pathological  and 
general  anatomy,  which  were  destined  to  control  the  medi- 
cine of  the  succeeding  century,  were  newly  created  and 
not  yet  regarded  as  sciences  by  themselves,  but  merely  as 
special  branches.  The  most  important  feature  was  the 
revival  and  more  accurate  study  of  experimental  physi- 
ology, which  had  been  scarcely  resorted  to  since  the  time 
of  Galen,  except  for  Harvey's  discoveries.  This  revival, 
which  4'eally  seemed  an  epoch  in  the  history  of  medicine, 
was  effected  by  the  great  Haller  (1708-1777),  of  Berne, 
— a  man  who  really  deserved  the  title  of  "  Great,"  as  he 
was  a  universal  and  indefatigable  savant,  possessed  of 
thorough  conscientiousness,  marvelous  capacity  for  work, 
great  ingenuity,  natural  endowments,  and  an  inextinguish- 
able love  for  art  and  science ;  he  was  certainly  one  of  the 
most  versatile  scholars  and  thinkers  of  any  time,  distin- 
guished not  only  in  his  chosen  field  of  medicine,  but  as  a 


HALLER.  221 

poet,  botanist,  and  statesman.  Like  all  Swiss  poets,  he 
never  passed  beyond  the  didactic  and  the  homely  in  his 
versification.  From  his  tenth  year  he  wrote  poems  in 
Latin  and  German,  and  even  when  eight  years  old  had 
made  most  extensive  compilations  from  Bayle's  dictionary. 
x\t  fifteen  he  went  to  the  University  of  Tiibingen,  where, 
in  the  second  year  of  his  sojourn,  he  disputed  with  one  of 
his  teachers.  In  1725  he  went  to  Ley  den,  where  Boer- 
haave  and  Albinus  found  in  him  a  most  indefatigable  fol- 
lower. At  nineteen  he  received  the  degree  of  doctor.  In 
the  excess  of  his  zeal  for  anatomy  he  purchased  for  a  con- 
siderable sum,  from  Albinus,  half  of  a  corpse,  the  other 
half  of  which  his  teacher  had  dissected ;  and,  while  in 
Paris,  he  even  engaged  in  grave-robbing,  and,  being- 
betrayed  by  his  own  carelessness,  was  compelled  to  save 
himself  by  flight.  In  many  other  States,  and  in  more  than 
one  country,  he  studied  with  the  best  of  teachers,  lecturing 
at  times  himself.  At  the  age  of  twenty-six  he  became 
professor  and  hospital  director  at  Berne,  and  in  1752  pub- 
lished his  famous  researches  on  irritability.  Three  years 
later  he  accepted  a  call  to  Gottingen  as  Professor  of  Anat- 
omy, Surgery,  Chemistry,  and  Botany.  He  was  the  founder 
of  a  botanical  garden ;  for  many  years  was  so  busy  that  he 
slept  and  lived  in  his  library;  and,  in  spite  of  his  enormous 
and  unique  correspondence  with  the  savants  of  the  world, 
he  never  left  a  letter  unanswered.  Strange  to  say,  his 
permanent  influence  upon  the  practice  of  medicine  was 
only  indirect;  and,  although  he  was  professor  of  surgery, 
and  performed  many  vivisections,  he  was  never  able  to 
persuade  himself  to  perform  a  single  surgical  operation 
upon  the  living  human  being.  He  it  was  that  introduced 
into  Germany  the  use  of  the  watch  in  counting  the  pulse. 
Like  Hunter,  Haller  demands  a  special  historian,  and  it  is 
possible  here  to  outline  only  a  few  of  the  services  he  ren- 
dered to  medicine.  He  enriched  the  anatomy  of  the  heart, 
of  the  brain  and  dura,  and  pointed  out  the  venous  nature 


*J22  THE    HISTORY    OF    MEDICINE. 

of  the  sinuses ;  taught  that  the  uterus  sliould  be  regarded 
as  a  muscle ;  advanced  the  knowledge  of  the  lymphatic 
system,  and  believed  in  and  taught  a  developmental  theory 
tliat  every  individual  is  descended  or  derived  from  a  pre- 
ceding- one.  In  the  mechanism  of  the  lieart  his  doctrine 
of  irritability  especially  maintained  itself,  lie  administered 
the  death-blow  to  the  doctrine  of  vital  spirits,  and  was,  in 
fact,  the  father  of  modern  nerve-physiology.  His  doctrine 
of  irritability  moved  the  minds  of  his  century  in  a  way 
that  has  no  parallel,  unless  we  compare  it  wdth  the  doctrine 
of  Darwin.  Glisson  had  estiiblished  the  general  principles 
of  irritability,  and  Haller  followed,  teaching  it  by  the 
inductive  method,  and  proving  its  existence  by  experiments, 
— proving,  moreover,  that  it  is  a  peculiarity  of  the  mus- 
cular substance  and  not  governed  by  ordinary  sensation. 
His  researches  deserve  the  more  credit  because  he  lacked 
modern  aids  to  physiological  study.  The  first  physiolog- 
ical institute  was  founded  in  Breslau  by  Purkinje,  some 
fifty  years  ago.  Haller  had  no  such  opportunity;  even  his 
successor,  the  great  Miiller,  possessed  no  such  advantages. 
The  profound  impression  made  by  Haller's  teachings  may 
be  measured  by  the  number  of  his  supporters  and  oppo- 
nents;  he  was  a  great  man,  second  only  in  wide-spread 
influence  to  Boerhaave,  and  one  wlio  left  a  more  lasting 
impress  upon  the  world  than  even  the  latter. 

The  two  best  known  of  Haller's  opponents  were: 
Wolf  (1733-1791),  of  St.  Petersburg,  who  regarded  each 
generation  as  an  actual  new  creation,  and  was  the  first  to 
teach  the  doctrine  of  the  blastodermic  membranes;  and 
Blumenbach  (1752-1840),  of  Gotha,  who  did  great  service 
by  investigations  in  general  anthropology,  of  which  he  was, 
in  fact,  the  founder,  and  whose  researches  in  comparative 
anatomy  and  the  history  of  development  have  rendered  him 
famous. 

Of  the  famous  anatomists  of  the  century  may  be  men- 
tioned Sommerring  (1755-1830),  of  Frankfort, — the  first 


ANATOMISTS   OF   THE    XVIII   CENTURY. 


223 


to  distinguish  the  facial  and  auditory  nerves  from  each 
otlier,  and  whose  pubHshed  Avorks  are  well  known,  because 
of  the  beautiful  illustrations  furnished  him  by  the  well- 
known  artist,  Koeck. 

The    ablest    French    anatomist   of    the    century    was 
Winslow  (1669-1760), — a  man  of  Danish  birth,  but  who 


Fig.  34.— J.  F.  Blumenbach. 

From  an  old  steel  engraving.) 


became  a  professor  in  Paris,  and  is  best  known  by  the 
foramen  named  for  him.  There  were,  also,  Portal 
(1742-1832),  physician  to  Louis  XVIII,  who  wrote  a 
famous  history  of  anatomy  and  surgery;  and  Vicq  d'Azyr 
(1748-1794),  known  equally  well  for  his  labors  in  the 
department  of  anatomy,  especially  of  the  brain,  nervous 


224  .  THE    HISTORY    OF   MEDICINE. 

system,  and  the  vocal  organs.  Bichat  (already  mentioned) 
would  deserve  to  be  placed  at  the  head  of  French  anat- 
omists were  it  not  for  his  superior  rank  in  clinical  medicine. 

The  founder  of  pathological  anatomy  as  a  science  was 
Morgagni,  born  in  1682,  in  Forli,  Italy, — a  pupil  of  Val- 
salva, and,  at  the  age  of  nineteen,  the  assistant  of  the 
latter.  It  was  not  until  his  seventy-ninth  year,  after  he 
had  published  several  works,  that  he  allowed  his  famous 
work  on  pathological  anatomy  to  appear.  This  is  the 
historical  classic,  De  Sedihus  et  Causis  Morboriun,  pub- 
lished in  Venice  in  1761.  Its  famous  author  did  not  cease 
work,  even  when  he  became  blind,  and  to  him  we  owe  the 
maxim  that  observations  should  be  "weighed,  not  counted." 
He  was  very  versatile,  and  well  informed  in  all  branches  of 
science  and  literature,  and  possessed  a  remarkable  memory; 
likewise  was  the  first  to  devote  attention  extensively  and 
thoroughly  to  the  anatomical  products  of  common  diseases, 
since,  before  his  time,  little  had  been  regarded  but  rare 
discoveries  in  the  body.  He  also  called  attention  to  the 
important  bearing  which  the  history  of  the  disease  has 
toward  its  products,  and  found  his  discoveries  of  advantage, 
even  when  they  were  unable  to  promote  the  cure  of 
disease,  because  of  the  light  which  they  threw  upon 
physiology  and  normal  anatomy,  and  because  they  pre- 
vented incurable  patients  from  being  continually  tormented 
with  drugs  intended  to  cure  them;  also  because  pathological 
investigations  alone  could  settle  disputes  in  diagnosis  and 
matters  of  honor  among  physicians.     He  died  in  1772. 

Morgagni's  legitimate  successors  in  Great  Britain  were 
Baillie  ( 1761-1823),  a  son  of  John  Hunter's  sister,  and  Sir 
Everard  Home, — Hunter's  brother-in-law, — who  became 
professor  in  the  Royal  College  of  Surgeons,  and  was  in- 
trusted by  Hunter  with  the  work  of  describing  his  collec- 
tion. Home,  however,  in  a  most  discreditable  way,  burned 
several  volumes  of  Hunter's  own  descriptions,  in  order  to 
appropriate  to  himself  the  sole  credit  of  the  work.     He 


PREVENTIVE   INOCULATION    AGAINST    SMALL-POX.        225 

has  gone  down  to  fame  especially  because  of  his  book  on 
the  prostate. 

One  of  the  most  notable  events  in  the  history  of  medi- 
cine was  the  introduction  of  the  systematic  practice  of 
preventive  inoculation  against  small-pox.  It  is  so  gener- 
ally taught  that  this  is  entirely  due  to  the  efforts  of  Jenner 
— or,  rather,  we  are  so  often  allowed  to  think  it,  without 
being  taught  otherwise — that  the  measure  deserves  an  his- 
torical sketch.  The  communication  of  the  natural  disease 
to  the  healthy,  in  order  to  afford  protection, — or,  in  other 
words,  the  communication  of  small-pox  to  prevent  the 
same, — reaches  back  into  antiquity.  It  is  mentioned  in 
tlie  Sanscrit  Vedas  as  performed  by  Brahmins,  who 
employed  pus  procured  from  small-pox  vesicles  a  year 
before.  They  rubbed  the  place  selected  for  operation  until 
the  skin  was  red,  then  scratched  with  a  sharp  instrument, 
and  laid  upon  it  cotton  soaked  in  the  variolous  pus,  moist- 
ened with  water  from  the  sacred  Ganges.  Along  with  this 
measure  they  insisted  upon  careful  hygienic  regulations,  to 
which,  in  large  measure,  their  good  results  were  due. 
Among  the  Chinese  was  practiced  what  was  known  as 
"pock-sowing,"  and  ten  centuries  before  Christ  the  Celes- 
tials introduced  into  the  nasal  cavities  of  young  children 
pledgets  of  cotton  saturated  with  variolous  pus.  The 
Arabians  inoculated  with  needles,  and  so  did  the  Circassians, 
while  in  North  Africa  incisions  were  made  between  the 
lingers,  and  among  some  of  the  negroes  inoculation  was 
performed  in  or  upon  the  nose.  In  Constantinople,  under 
the  Greeks,  the  custom  had  long  been  naturalized,  and  was 
practiced  by  old  women,  instructed  in  the  art,  who  regarded 
it  as  a  revelation  of  Saint  Mary.  The  first  accounts  of  this 
practice  were  given  to  the  Royal  Society  by  Timoni,  a  phy- 
sician of  Constantinople,  in  1714.  The  actual  introduction 
of  the  practice  into  the  West,  however,  was  due  to  Lady 
Mary  Wortley  Montagu,  who  died  in  1762,  and  wlio  was 
wife  of  the  English  Ambassador  to  the  Porte  in  1717.    She 


226  THE    HISTORY    OF    MEDICINE. 

liad  her  sou  inoculated  in  Constantinople,  by  Maitland,  and 
on  lier  return  to  London,  in  1721,  her  daughter  also  was 
inoculated.  Daring  the  same  years  experiments  were  under- 
taken by  Maitland  upon  criminals,  and,  as  these  turned  out 
favorably,  the  Prince  of  Wales  and  his  sisters  were  inoc- 
ulated by  Mead.  The  practice  was  then  more  or  less 
speedily  adopted  on  this  side  of  the  Atlantic,  but  suffered 
occasional  severe  blows,  because  of  unfortunate  cases  here 
and  there,  such  as  never  can  be  avoided.  The  clergy, 
especially,  using  the  Scripture,  as  designing  men  can  always 
do,  became  warm  opponents  of  the  practice,  and  stigmatized 
it  as  an  atrocious  invasion  of  the  divine  prerogative.  Never- 
theless, in  1746  the  Bishop  of  Worcester  recommended  it 
from  the  pulpit,  established  houses  for  inoculation,  and  thus 
made  it  again  popular.  In  Germany  it  was  generally 
favored,  and  a  little  later  came  into  vogue  in  France  and 
Italy.  In  1757  Robert  Sutton,  near  London,  professed  to 
have  made  fifteen  thousand  inoculations  without  a  single 
fatal  case;  he  kept  his  patients  on  a  strict  diet  for  nine 
days,  then  inoculated  with  the  smallest  possible  quantity  of 
virus.  The  operation  was  not  prohibited  in  England  until 
the  year  1840,  although  it  involved  much  greater  dangers 
than  vaccination  with  cow-pox. 

The  first  inoculation  witli  cow-pox  seems  to  have  been 
performed  in  1774  by  a  farmer  of  Gloucester,  named  Jesty, 
though  the  pioneer  in  the  extensive  and  general  introduc- 
tion of  this  method  was  Edward  Jeuner  (1749-1823),  of 
Berkeley,  in  Gloucestershire,  who,  therefore,  is  generally 
known  as  the  "  Father  of  Vaccination."  The  son  of  a 
clergyman,  he  began  early  the  study  of  medicine  and  sur- 
gery, and  during  his  apprenticeship  received  from  a  milk- 
maid information  of  the  protective  power  of  cow-pox  against 
variola,  as  established  by  popular  observation.  (Sutton 
and  otliers  had  proved  that  inoculation  of  s7ieep-])0X  was 
not  efficient.)  This  communication  so  struck  Jenner  as 
a    means  of  affording    protection    to    the  whole    human 


JENNER,    THE    "FATHER   OF   VACCINATION."  227 

race  that  the  subject  never  afterward  left  his  mind.  In 
1770  he  became  a  pupil  of  John  Hunter,  and  when  he 
communicated  to  him  this  idea  the  great  surgeon  said: 
"  Do  not  think  ;  investigate ! "  Accordingly  he  went  to 
Berkeley  and  performed  the  little  operation  which  has 
made  him  famous;  and  from  1778  until  1788  he  commu- 
nicated to  Sir  Everard  Home  such  observations  as  he  had 
made.     But  the  first  vaccination  was  performed  in  1796, 


Fig.  35.— Edwaed  Jenner,  M.D. 

(From  a  steel  engraving  by  E.  Scriven  made  from  a  painting  by  J.  R.  Smith.) 

upon  a  boy,  with  matter  from  the  hand  of  a  maid  who  had 
contracted  cow-pox  in  milking.  In  1798  he  published  his 
memorable  work,  and  afterward  removed  to  London.  He 
died  full  of  fame  and  honor,  in  his  native  place,  having 
received  rewards  from  the  government  amounting  to  one 
hundred  and  fifty  thousand  dollars,  besides  being  made  an 
honorary  citizen  of  tlie  city  of  London.  The  subsequent 
wide-spread  practice  of  the  method,  and  the  formation  of 


228  THE   HISTORY    OF   MEDICINE. 

societies  for  the  promotion  of  vaccination  are  matters  of 
recent  history. 

The  first  vaccinations  in  the  United  States  were  per- 
formed by  Doctor  Waterliouse,  Professor  of  Medicine  in 
Harvard  College,  in  1800,  upon  four  of  his  ovi-n  cliildren. 
The  transmission  of  humanized  virus  thiougli  the  system 
of  the  cow,  and  its  subsequent  employment  in  vaccination 
of  human  beings,  was  first  practiced  by  Troja  (1747-1827), 
of  Naples,  shortly  after  the  introduction  of  human  vaccina- 
tion ;  but  in  1810  tliis  was  prohibited  in  Italy.  Compul- 
sory vaccination  was  first  extensively  introduced  in  Germany 
in  1807;  in  England  it  was  first  legalized  in  1827.  The 
occasional  temporary  character  of  the  protection  thus 
afforded  was  first  taught  by  Elsasser  in  1814.  Schoenlein 
was  the  first  to  call  attention  to  the  distinction  between 
variola  and  varioloid. 

Another  matter  in  which  the  eighteenth  century  wit- 
nessed great  reform  was  the  treatment  of  the  insane,  which 
continued  in  very  bad  condition  until  toward  the  close  of 
the  century,  when  a  movement  for  improvement  began. 
From  and  after  this  lunatics  were  liberated  from  their 
fetters  and  from  the  hands  of  brutal  keepers,  and  regarded 
as  actually  ill,  while  so-called  schools  of  psychiatry  were 
founded.  While  the  first  impulse  in  this  direction  was 
given  by  Lorry,  the  true  reformer  was  Pinel,  already  men- 
tioned, who  did  away  witli  corporeal  punishment  and 
abuse,  separated  the  insane  from  convicts,  limited  the  em- 
ployment of  drugs  and  especially  venesection,  placed  the 
unfortunates  in  special  institutions  under  the  charge  of 
physicians,  and  classified  patients  accordinj^  to  their  symp- 
toms. Yet,  in  spite  of  his  humane  teacliings,  lunatics  were 
found  incarcerated  in  cages  in  some  of  the  French  cities  as 
late  as  1834.  Pinel  was  followed  by  Esquirol  (1772-1840), 
who  in  1818  establislied  the  first  clinic  for  mental  diseases. 

It  is  well  known  what  a  conspicuous  part  public  baths 
played  in  the  social  life  of  the  ancient  Greeks  and  Romans, 


HYDROTHERAPY.  229 

but  the  first  public  resort  for  sea-bathing  was  established 
in  Germany  in  1 794.  The  cold-water  epoch  of  this  cent- 
ury, however,  began  with  the  researches  of  Hahn  (1696- 
1773),  a  Silesian,  who  introduced  a  systematic  and  almost 
exclusive  hydrotherapeutic  method.  The  modern  method 
of  using  cold  water  as  an  antipyretic  agent  was  first  em- 
ployed in  England,  in  1797,  by  Currie,  who  originally  was 
an  American  merchant.  In  France  the  method  found 
little  sympathy,  but  it  made  its  way  even  to  Spain  later, 
where  it  was  adopted  by  the  famous  Sangrado,  who  is  well 
known  to  readers  of  Gil  Bias. 


CHAPTER  IX. 

The  Age  of  Eenovation  {continued). — The  Eighteenth  Century  ;  General 
Considerations.  Foundation  of  Learned  Societies,  etc.  The  Koyal  College 
of  Surgeons,  1800 ;  the  Josephinuni,  1785. — The  Nineteenth  Century. 
Realistic  Reaction  Against  Previous  Idealism.  Influence  of  Comte,  of 
Claude  Bernard,  and  of  Charles  Darwin,  1809-1882.  Influence  Exerted  by 
Other  Sciences. — Theory  of  Excitement :  Roeschlaub. — Stimolo  and  Contra- 
stimolo  :  Rasori,  1762-1837. — Homwopathy :  Hahnemann,  1753-1843. — Isop- 
afhy,  Elect rohomoeopathy  of  Mattel. — Cranioscopy,  or  Phrenology:  Gall  and 
Spurzheim. — The  Physiological  Theory:  Broussais,  1772-1838. — Paris  Patho- 
logical School:  Cruveilhier,  1791-1873.  Andral,  1797-1876.  Louis,  1787- 
1872.  Magendie,  1783-1855.  Trousseau,  1801-1866.  Claude  Bernard, 
ISl'i-lSlS.— British  Medicine:  Bell  and  Hall,  Travers,  1783-1858.— 
Germany,  School  of  Natural  Philosophy:  Johannes  Mliller,  1801-1858. — 
School  of  Natural  History:  Schonlein,  1763-1874. — Neio  Vienna  School: 
Rokitansky,  1804-1878.     Skoda,  1805-1881. 

That  tlie  eighteenth  century,  up  to  its  close,  was  the 
golden  age  of  medicine,  is  due  to  the  prevalence  during 
that  period  of  a  strong  idealistic  undertone,  as  a  result  of 
which  any  learned  occupation  caused  the  scholar  to  be  held 
in  higher  esteem  than  is  the  case  even  to-day.  Medicine 
was  then  regarded  as  a  conscientious  vocation  and  not  as  a 
mere  business  or  trade;  indeed,  general  scientific  knowledge 
more  widely  prevailed  among  the  better  class  of  the  profes- 
sion, and  there  was  much  less  of  that  one-sided,  narrow  edu- 
cation that  obtains  to-day.  The  profession,  moreover,  was 
not  overcrowded ;  physicians  were  neither  too  few  nor  too 
numerous,  consequently  their  social  position  was  higher. 
Again,  the  relations  between  doctor  and  patient  were  more 
intimate,  most  practitioners  being  of  the  type  described  as 
"  family  physicians,"  and  those  possessed  of  the  doctorate 
degree  ranked  among  the  gentry  rather  than  as  artisans. 
They  were,  for  the  most  part,  fully  devoted  to  their  call- 
ing; moreover,  the  State  took  greater  care  to  protect  the 
people,  so  that  it  became  dangerous  for  strolling  vagabonds 
and  impostors  to  attempt  to  trifle  with  human  life  and 
excite  the  vulgar  to  the  prejudice  of  scientific  knowledge. 
(230) 


HOSPITALS    AND    CLINICS.  231 

The  pursuit  of  anatomical  studies  was  now  facilitated, 
despite  the  fact  that  students  were  frequently  compelled  to 
take  long  journeys  in  order  to  obtain  the  "material"  there- 
for. In  the  early  part  of  the  century  so  great  was  the  lack 
of  dissecting  material  that  the  great  Haller  while  in  Paris 
was  compelled  to  purloin  his  cadavers,  and  ultimately,  on 
discovery  of  this  fact,  to  fly  for  his  life  ;  Hoffmann  was  only 
able  to  make  twenty  dissections  during  twenty-four  years; 
even  in  the  middle  of  the  century  there  was  only  one  dis- 
section annually  in  Halle;  up  to  1712  there  had  been  only 
three  dissections  in  a  score  of  years — though  now  subjects 
can  be  had  there  in  abundance  at  a  ridiculously  low  figure ; 
cadavers  were  extremely  scarce  in  Vienna  as  late  as  1765 ; 
and  for  a  long  time  the  only  places  in  London  where  the 
study  of  anatomy  could  be  legally  pursued  were  the  College 
of  Pliysicians  and  the  College  of  Surgeons,  and  the  trouble 
that  hampered  John  Hunter  in  this  direction  is  historical. 
The  crime  of  "Burking"  became  known  in  Hunter's  day. 
Murder  was  committed,  and  the  victim  sold  for  purposes 
of  dissection — for  at  this  time,  as  "body-snatching"  was  a 
necessity,  those  that  purchased  cadavers  asked  few  ques- 
tions, and  the  fees  paid  were,  of  course,  high. 

The  first  clinical  institution  in  Austria  was  organized 
in  Vienna,  in  1754,  by  Van  Swieten,  though  there  was  an 
"ambulatory  clinic"  (out-patient  department)  in  Prague 
nine  years  before.  During  the  century,  however,  hospitals 
were  everywhere  in  bad  condition.  In  the  Hotel-Dieu,  at 
Paris,  several  patients — even  a.s  many  as  six — were  some- 
times put  in  the  same  bed ;  the  convalescent  and  the  dying 
found  themselves  thus  associated ;  in  Vienna  the  Allge- 
meines  Krankenhaus  was  composed  of  seventeen  hospitals 
that  subsequently  were  amalgamated  into  one.  In  London 
numerous  hospitals  were  founded,  and  as  the  medical  staff 
of  each  became  eminent  they  attracted  numerous  pupils ; 
but  later  it  became  necessary  to  relieve  the  hospital  wards, 
and  private  institutions  for  instruction  were  established  by 


232  THE    HISTORY   OF   MEDICINE. 

popular  teachers,  the  most  celebrated  being  the  "Windmill 
Street  School  of  Anatomy,"  founded  by  William  Hunter 
about  1770,  and  the  private  school  of  Sir  William  Bliz- 
zard, which,  established  in  1780,  developed,  five  years 
later,  into  the  London  Hospital  Medical  School. 

While  few,  if  any,  of  the  lectures  were  compulsory, 
particularly  in  the  natural  sciences,  even  more  attention 
than  now  was  bestowed  upon  the  accessory  branches ;  botany, 
chemistry,  and  natural  history  were  the  recreation  of  many 
students  and  physicians.  Pupils  enjoyed  the  privilege  of 
studying  what  they  pleased — as  they  do  practically  to-day 
in  the  Portuguese  University  of  Coimbra, — and  professors 
exercised  to  the  utmost  their  individuality  in  teaching.  In 
Spain  natural  sciences  found  no  admission,  and  even  so  late 
as  1770  no  instruction  in  these  branches  was  given,  as  they 
were  regarded  as  dangerous  to  the  purity  of  tlie  faith;  min- 
eralogy for  mining  purposes  was  an  exception,  for  even  the 
most  faithful  Catholic  needs  money. 

At  the  universities  medical  students  were  not  permitted 
to  go  out  without  their  scholastic  cloaks, — a  regulation  that 
still  obtains  in  Spain.  •  That  the  number  of  students  has 
enormously  multiplied  may  be  seen  from  the  fact  that  the 
little  University  of  Giessen,  with  scarcely  any  medical  school 
at  all,  has  always  more  students  than  had  Halle  in  the  days 
of  the  famous  Hoffmann.  In  the  middle  of  the  last  cent- 
ury Wiirzburg  had  at  one  time  but  three  medical  students, 
while  to-day  it  has  in  the  neighborhood  of  five  hundred. 
Even  then  it  was  complained  that,  on  account  of  the  number 
of  students,  there  was  an  educated  proletariat  arising,  and 
in  1791  it  was  proposed,  in  Austria,  that  the  rush  for  study 
should  be  repressed. 

Among  the  Continental  students  the  revels  and  bad 
behavior  of  past  centuries  were  not  to  any  great  extent 
corrected;  fights  and  debauchery  were  very  common,  and 
aU  sorts  of  orgies  and  bacchanals  prevailed.  The  profes- 
sors were,  in  large  measure,  independent  of  the  State,  and 


PREJUDICE   AGAINST   THE   JEWS.  233 

a  single  individual  often  represented  a  number  of  branches 
now  taught  by  special  chairs.  When  indisposed  to  lecture, 
they  simply  posted  upon  the  blackboard:  "■  Hodle  nmi 
legitu7\'^  and  this  was  the  end  of  the  matter.  In  1777 
Vienna  had  one  hundred  and  forty-seven  medical  teachers, 
and  in  Germany  there  were  two  to  every  thirty-nine 
students.  That  in  the  last  century  one  man  often  accom- 
plished more  than  a  great  number  of  average  teachers  do 
to-day  is  amply  demonstrated  by  the  lives  of  Boerhaave, 
Haller,  and  others.  Then,  too,  the  Latin  tongue  was 
generally  employed  for  purposes  of  instruction,  tliough  sur- 
geons, for  the  most  part,  lectured  in  the  vernacular;  Cullen, 
in  1770,  was  the  first  in  Great  Britain  to  deliver  purely 
medical  lectures  in  English ;  and  as  the  clergy  gradually 
retired  from  the  ranks  of  the  profession,  Latin  more  and 
more  fell  into  disuse.  Strange  to  say,  as  the  clerical 
influence  waned,  the  Jews  began  to  enter  medicine,  the 
movement  beginning  about  1791,  in  France,  under  the 
promulgation  of  "  civil  equality "  ideas ;  previously  the 
Hebrews  had  been  an  almost  universally  suppressed  people, 
and  in  Berlin  were  permitted  to  enter  and  leave  the  city 
by  only  one  gate,  and  were  forbidden  to  learn  or  write 
pure  German,  in  consequence  whereof  their  dialect  was  an 
Hebraic-Teutonic  jargon,  that  even  to-day  prevails  in  some 
portions  of  western  Europe.  Educated  Jews  were  few  in 
number,  since  attendance  upon  universities  was  ordinarily 
denied  them,  although  long  before  they  had  been  admitted 
at  Salamanca,  Toledo,  Salernum,  and  Montpellier.  In 
Austria  the  prohibition  was  not  removed  until  1789,  and 
even  then,  so  bitter  was  the  prejudice  against  the  Semitic 
race,  the  clergy  vigorously  protested.  It  was  the  same 
clerical  body  that,  in  1667,  protested  with  tlie  greatest 
vehemence  against  allowing  Hebrew  physicians  to  pass 
through  the  gates  of  Wiirtemburg  without  paying  toll, 
declaring  that  it  was  "  better  to  die  with  Christ  than  be 
cured  by  Jews,  wlio  were  aided  by  the  devil." 


234  THE    HISTORY   OF   MEDICINE. 

Professors  were  often  attached  to  the  courts  of  their 
various  sovereigns,  and  at  one  time  the  French  court  pos- 
sessed a  faculty  of  forty-eight  physicians,  surgeons,  and 
apothecaries,  the  first  two  physicians  being  required  to 
attend  every  morning  when  the  king  arose;  hence  orig- 
inated the  titles,  still  known  in  Germany,  of  "  Hofrath  " 
and  "Geheimrath." 

Medical  fees,  as  a  rule,  were  very  small,  though  there 
were  exceptional  instances  in  which  enormous  sums  were 
bestowed:  Joseph  II,  of  Austria,  gave  Guerin,  who  was 
summoned  from  Paris  in  consultation,  an  honorarium  of 
171,000  marks  and  made  him  a  baronet.  Taking  all  things 
into  consideration,  the  income  of  the  average  practitioner 
in  the  eigliteenth  century  would  be  in  the  neighborhood  of 
$1000,  which,  however,  was  equivalent  to  three  times  that 
amount  to-day.  Fothergill,  whose  highest  income  in  a 
single  year  was  $25,000,  bequeathed  to  the  poor  of  London 
$1,000,000;  Sir  Astley  Cooper  had  a  yearly  income  of 
from  $75,000  to  $100,000,  but  it  may  be  remembered  that 
his  practice  during  the  first  year  netted  him  just  $26,  and 
that  it  was  four  years  later  before  his  income  reached  the 
sum  of  $500. 

The  physician  of  the  last  century  was,  at  least,  on  occa- 
sions of  moment,  very  different  from  other  men,  and  to  be 
recognized  by  his  dress.  A  cap  was  placed  upon  his  head 
when  he  graduated,  in  recognition  of  the  fact  that  physi- 
cians at  an  earlier  period  belonged  to  the  learned  or  cler- 
ical profession  ;  and  in  later  life  he  wore  a  purplish  or 
scarlet  cloak  (to  distinguish  him  from  lawyers,  whose  pro- 
fessional color  was  yellow,  and  from  tlieologians,  who  then, 
as  now,  sported  the  sombre  black).  The  regulation  full- 
dress  costume  of  the  English  physician  of  the  last  century 
demanded  a  well-powdered  wig,  silk  coat,  knee  breeches 
with  stockings,  buckled  shoes,  lace  ruffles,  cap,  and  gold- 
headed  cane,  to  which,  in  cold  weather,  was  added  a  muff" 
— to  preserve  his  delicacy  of  touch. 


FOUNDATION    OF    SOCIETIES   AND    ACADEMIES.  235 

Surgeons  were  still  strictly  separated  from  pliysicians, 
even  in  education;  nor  were  they  esteemed  as  equal  in 
rank,  until  the  French  Revolution  brought  about  the  doc- 
trine of  civil  equality ;  perhaps  this  is  one  reason  why  this 
branch  of  the  medical  art  made  less  conspicuous  progress 
until  recent  times.  The  change  was  brought  about,  in 
France,  by  the  abolition  of  eighteen  universities  and  fifteen 
colleges  of  medicine,  the  Royal  Society  of  Medicine  (founded 
in  1776),  and  the  Academy  of  Surgery  (founded  in  1731); 
but  by  this  abolition  charlatanism  acquired  such  speedy 
control  that  the  arrangement  was  soon  abandoned.  Thus 
it  came  about  that  surgical  instruction  was  given  in  special 
institutions  or  in  the  universities,  and  the  conditions  of 
instruction  finally  improved.  When  the  College  of  St. 
Come  was  abolished  in  1753  the  Societe  de  Chirurgie, 
founded  in  1731,  became  the  Academie  de  Chirurgie; 
and,  when  the  French  Academy  was  formed  in  1795,  the 
Academie  was  merged  into  its  medical  department.  The 
Ecole  Pratique,  where  Desault  and  Chopart  taught,  was 
established  in  1750  for  the  practical  education  of  surgeons. 
In  England  the  Royal  College  of  Surgeons  was  not  incor- 
porated until  1800.  In  Austria,  in  1785,  the  Josephinum 
was  opened  by  Joseph  II,  who  also  erected  permanent 
military  hospitals  .in  Prague,  Briinn,  Milan,  Mantua,  Pesth, 
Olmiitz,  etc. ;  he  also  created  the  "Joseph's  Akademie"  in 
order  to  educate  military  surgeons  and  thus  overcome  the 
defects  of  army  surgery ;  the  Josephinum  unquestionably 
exerted  great  influence  in  elevating  the  social  and  military 
position  of  army  siugeons  and  attained  historical  impor- 
tance after  Brambilla  compelled  the  recognition  of  sur- 
geons as  social  equals  of  other  members  of  the  medical 
profession.  As  the  result  of  these  improvements,  the  va- 
rious armies  of  Europe  were  soon  furnished  with  better 
medical  officers.  Prior  to  this,  too,  the  field  hospitals  had 
been  as  badly  mismanaged  as  their  civil  prototypes,  and 
the  substitution,  in   1793,  of  movable  hospitals,  as    sug- 


236  THE    HISTORY    OF    MEDICINE. 

gested  at  the  close  of  the  sixteenth  century  by  Henry  IV, 
of  France,  was  scarcely  an  improvement.  The  whole  sys- 
tem suffered  from  perpetuation  of  the  dual  and  distinct 
functions  of  the  physician  and  the  surgeon,  to  destroy 
which  was  a  part  of  the  design  of  the  Josephinum.  How 
unpleasant  was  the  position  of  the  army  surgeon  up  to  this 
date  may  be  inferred  from  the  fact  that  in  1758  one  was 
subjected  to  corporeal  punishment  at  the  command  of  his 
colonel,  and  that  a  general  upon  his  death-bed  could  leave 
orders  tliat  fifty  blows  be  given  each  of  his  medical  staff  in 
case  the  post-mortem  disproved  the  diagnosis. 

In  Austria,  at  the  beginning  of  the  Seven  Years'  War, 
all  military  surgeons  of  the  Protestant  faith  were  compelled 
to  become  Catholics  or  leave  the  service.  The  condition 
of  the  wounded  soldiers  was  as  deplorable  as  can  well  be 
imagined ;  but  upon  this  subject  I  cannot  dwell. 

The  tendency  of  the  nineteenth  century  seems  to  be  a 
continuation,  and,  perhaps,  in  some  respects,  an  exagger- 
ation, of  the  condition  obtaining  in  France  during  the 
previous  century ;  in  other  words,  the  world  has  become 
practically  an  enormous  school  of  pathological  anatomy 
and  diagnosis, — a  school  inaugurated  by  Bichat,  as  repre- 
senting so-called  scientific  or  exact  medicine.  Pliilosoph- 
ically  this  has  been  a  century  of  reaction  against  the 
idealism  of  the  preceding  age ;  it  places  the  individual, 
rather  than  the  idea,  in  the  foregound.  The  mutual  influ- 
ence of  medicine,  philosophy,  and  the  natural  sciences  is 
less  conspicuous  now  than  formerly.  Recent  philosophers 
who  liave  exercised  tlie  greatest  influence  are :  Schelling, 
wlio  held  to  the  equality  of  the  real  and  the  ideal ;  Hegel, 
whose  supreme  principle  was  absolute  reason,  of  which 
religion  was  regarded  as  a  representation ;  Hartmann, 
whose  philosophy  of  tlie  "unconscious"  depends  largely 
upon  the  results  of  natural  sciences,  embraces  Darwinism, 
and  is,  in  many  respects,  an  extension  and  completion  of 


INFLUENCE    OF    DARWIN    AND    SPENCER.  237 

Schopenhaviei's  pessimism  and  doctrine  of  the  soul.  But 
one  who  lias  exercised  still  more  influence  upon  our  pro- 
fession is  Comte,  whose  positivism  contrasted  strongly  with 
the  idealism  and  atheism  of  Schelling,  and  who  required 
only  this  of  philosophy, — namely,  that  it  should  work  out 
the  general  ideas  and  results  of  other  sciences ;  his  most 
important  follower  was  Claude  Bernard,  and  upon  these 
two  the  whole  exact  school  of  Fiance  is  based.  But  the 
most  influential  philosophic  doctrines  of  this  or  any  other 
century  have  been  those  emanating  from  Charles  Darwin, 
Herbert  Spencer,  Ernst  Haeckel,  Alfred  Wallace,  and 
their  contemporaries  and  followers.  Darwin  (1809-1882) 
was  the  grandson  of  Erasmus  Darwin,  already  mentioned, 
and  his  Variation  of  Animals  and  Plants  Under  Domes- 
tication, Origin  of  Species,  and  Descent  of  Man  have 
found  a  place  in  all  modern  languages.  The  system 
known  by  his  name  is  the  pure  science  of  nature,  is 
founded  upon  scientific  investigation,  and  by  its  merits 
alone  has  found  almost  universal  acceptance ;  it  has  been 
added  to  and  further  elucidated  by  the  efibrts  of  Haeckel 
and  Spencer. 

When  it  is  declared  that  medicine  of  the  present  is 
influenced  by  no  system,  it  is  speedily  found,  on  critical 
analysis,  that  this  is  an  error.  It  necessarily  follows  the 
realistic  and  materialistic  as  readily  as  it  did  the  teachings 
and  doctrines  of  natural  philosophy ;  and,  in  consequence, 
"  medical  thought,"  so  called,  is  just  as  one-sided  to-day  as 
at  any  time  in  the  history  of  the  art.  The  watchword  of 
to-day,  "  natural  specific  tendency,"  veils,  but  does  not 
take  away,  its  philosophic  principles,  and  so  our  ridicule 
of  earlier  medical  systems  is  quite  unjustifiable.  A  modern 
historian  aptly  remarks  that  the  medicine  of  the  present 
"  embraces  nothing  but  a  theorem  of  investigation  by  the 
senses." 

Discoveries  hi  botany,  the  result  of  better  knowledge  of 
natural  history  and  more  accurate  habits  of  study,  have 


238  THE    HISTORY    OF    MEDICINE. 

iuflueiiced  modern  progress  not  a  little;  have  led  to  better 
classification  and  broader  knowledge.  The  natural  system 
of  de  Candolle  (1778-1841),  of  Geneva,  and  of  Endlicher, 
of  Vienna,  called  into  existence  the  so-called  natural  his- 
torical school  of  medicine ;  the  researches  into  plant-cells 
by  Schleideii  and  Baumgartner,  and  the  almost  contem- 
poraneous discovery  of  animal  cells  by  Schwann  became, 
in  course  of  time,  the  origin  of  recent  cellular  pathology ; 
then  came  microscopic  botany,  and  the  influence  of  the 
lower  fungi  in  the  production  of  fermentation  and  putre- 
faction. 

Similarly,  too,  the  laws  of  physics  have  been  shown  to 
have  an  inseparable  connection  with  anatomy  and  phys- 
iology, and  their  study  has  become  a  most  important  aid 
in  the  experimental  researches  of  to-day ;  through  Helm- 
holz  they  brought  in  the  ophthalmoscope ;  thermal  elec- 
tricity, for  the  discovery  of  which  medicine  is  indebted  to 
Seebeck ;  a  better  knowledge  of  optics,  thanks  to  Fraun- 
hofer,  who  was  equally  expert  in  electricity;  spectrum 
analysis,  invented  by  Kirchhoff ;  and  the  varied  efforts  of 
Faraday,  Graham  Bell,  Thomas  Alva  Edison,  and  Da- 
guerre,  the  latter  better  known  for  his  invention  of  photog- 
raphy. Finally,  medicine  is  immeasurably  indebted  to 
Tyndall  and  Huxley  for  their  teaching  of  the  correlation 
and  conservation  of  energy. 

Chemistry  also  has  performed  its  share,  and,  as  applied 
to  physiology,  is  a  discovery  almost  wholly  within  the 
present  century.  The  new  nomenclature  serves  a  practical 
purpose  in  that  it  is  now  possible  to  ])ortray  chemical  com- 
binations and  isomerism  in  a  graphic,  and.  at  least,  semi- 
comprehensive  way.  Among  the  chemists  may  be  specially 
mentioned  Bertliolet,  whose  laws  are  as  well  known  as 
they  are  succinct ;  Humboldt ;  Berzelius  ;  Dumas  ;  Chev- 
reuil,  who  recently  died  at  the  age  of  almost  one  hundred 
years;  Magendie  ;  Orfila,  the  toxicologist ;  Gmelin,  eminent 
in  physiological  chemistry  ;  Rose,  perfecter  of  organic  anal- 


RAPID    MULTIPLICATION    OF    SCIENTIFIC    LITERATURE.      239 

ysis;  Wohler,  who  first  made  organic  alkaloids;  Biiiisen; 
Sir  Humphry  Davy;  Marsh;  Faraday;  Graham;  Young, 
who  first  showed  the  industrial  value  of  coal ;  and  Gay- 
Lussac. 

Upon  medicine,  zoology  also,  with  comparative  anatomy 
and  pliysiology,  lias  had  a  wonderful  influence ;  here  may 
be  noted  the  names  of  Cuvier,  Okeii,  Bilharz,  Brehm, 
Wagner,  Leuckart,  Richard  Owen,  William  Carpenter,  and 
last,  but  by  no  means  least,  Thomas  Huxley. 

But  perhaps  the  most  significant  feature  of  the  age  has 
been  the  wonderful  development  of  scientific  associations 
and  the  publication  of  medical  and  scientific  literature. 
Whether  these  have  yet  reached  their  climax  is  perhaps  an 
open  question,  but  the  consequent  widening  circle  of 
readers,  as  well  as  of  writers,  seems  to  imply  that  there 
will  be  for  a  long  time  to  come  no  lack  of  activity  in  this 
direction.  In  the  United  States  more  than  in  anv  other 
country  medical  societies  and  associations  innumerable 
have  sprung  up,  and  to  such  a  degree  that  (in  the  eastern 
States  at  least)  there  are  few  counties  that  cannot  boast  of 
a  medical  organization. 

During  the  present  century  foreign  universities  have 
decreased  in  number,  partly  owing  to  consolidations  and 
partly  by  surrender  of  charters ;  for  instance,  the  old  Uni- 
versity of  Ingolstadt  was  united  with  that  of  Landshut,  and 
in  1827  was  removed  to  Munich;  in  1816  the  University 
of  Wiirtemburg  was  united  with  that  of  Halle ;  the  Uni- 
versity of  Bonn  was  abolished  in  1792,  but  revived  in  1818. 
A  few  new  universities,  like  that  of  Ziirich,  have  been 
founded.  In  the  quaint  old  town  of  Prague  the  old 
German  university  was,  in  1883,  divided, -and  there  now 
exist  in  that  city  two  universities  side  by  side,  in  one  of 
which  German  is  spoken,  in  the  other  Bohemian. 

It  will  thus  be  seen  that  the  nineteenth  century  is 
essentially  an  era  of  modern  science,  with  W'hose  dawn  was 
sounded  the  death-knell  of  the  "demon  of  disease"  and  his 


240  THE   HISTORY    OF   MEDICINE. 

twin  brother  "visitation."  In  1801  the  first  experiment  in 
steam-navigation  took  place  upon  the  Thames.  In  1807 
the  slave-trade  in  England  was  abolished  by  Parliament. 
The  theological  part  has  entirely  faded  out  of  medicine ; 
and  the  era  of  accurate  scientific  experimentation  whicli 
long  since  dawned,  is  now,  so  far  as  we  can  see,  at  its 
lieight,  since  it  is  difficult  to  conceive  of  much  improve- 
ment upon  its  methods  under  existing  conditions,  or  of 
greater  enthusiasm  than  has  been  already  manifested. 

Now,  regarding  some  of  the  systems  and  theories  of  this 
age.  The  systems  of  the  past  have  been  more  or  less  long- 
lived, — as,  for  instance,  those  of  Dogmatism  and  of  Galen, 
— while  as  we  come  closer  to  the  present  they  become  more 
ephemeral.  Those  of  the  early  part  of  the  present  century 
took  root  in  the  soil  of  the  eighteenth, — for  instance,  the 
so-called  theory  of  excitement  of  Roeschlaub  (1768-1835), 
which  endeavored  to  mold  into  one  the  Brunonian  errors 
and  the  fancies  of  Schelling.  According  to  it,  life  depends 
upon  irritability,  but  is  inherent  in  the  organism  as  an 
independent  feature ;  so  it  recognizes  both  irritability  and 
solidism,  while  Brown  considered  the  former  alone,  adding, 
as  an  after-thought,  a  chemical  or  qualitative  potency 
(oxygen),  in  order  to  account  for  alterations  of  quality. 
Roeschlaub  inclined  first  toward  natural  philosophy,  then, 
owing  to  an  inherent  theological  and  polemical  bias  (he 
was  originally  intended  for  the  church),  to  mysticism  and 
theosophy ;  finally,  with  a  courage  almost  unexampled,  he 
upset  all  his  former  teachings  by  admitting  he  was  mis- 
taken. To  him  was  opposed  Hufeland,  who  wrote  on  the 
Lengthening  of  Life^  was  noted  for  a  warm  and  benevo- 
lent heart,  and  possessed  no  small  penetration,  as  is  evi- 
denced by  his  aphorism,  "  Successful  treatment  requires 
one-third  science  and  two-thirds  '■  savoir  faireJ'  " 

StimoJo  and  contrast imolo  were  titles  applied  to  a 
theory  advanced  by  Rasori  (1762-1837),  of  Milan,  that 
combined  Methodism  with  Brunonism ;  by  Baas  it  is  char- 


HOMCEOPATHY    AND   ISOPATHY.  241 

acterized  as  a  "geiniine  blot  upon  the  human  heart  beyond 
any  other  of  the  various  systems."  Long  centuries  of  ex- 
perience and  the  conckisions  of  great  and  venerable  minds 
may  go  for  naught,  as  Rasori  abundantly  demonstrated. 
The  theories  of  Brown  were  then  taught  as  his  own  to  his 
classes  in  Pavia,  showing  he  was  not  above  plagiarism ;  his 
stimolo  corresponded  to  the  sthenic  diathesis  devised  by 
Erown,  wliile  his  system  consisted  of  an  endeavor  to  make 
a  diagnosis  by  watching  the  eflfects  of  drugs.  Bleeding  was 
held  to  be  the  best  measure ;  if  it  did  the  patient  good,  the 
sthenic  diathesis  was  assumed ;  if  it  made  him  worse,  the 
asthenic  was  certain.  He  gave  enormous  doses  of  power- 
ful drugs — sixty  grains  of  gamboge,  and  from  two  to  three 
ounces  of  saltpeter  in  a  single  day.  Is  it  strange  that 
homoeopathy  or  any  other  heterodox  system  sprang  up 
in  the  midst  of  such  measures'?  It  is  an  old  saying  that 
there  is  no  folly  which  will  not  secure  a  following ;  and, 
strange  to  say,  Rasori  had  a  numerous  and  an  eminent 
one. 

As  just  intimated,  Homceopathy  was  the  natural  reac- 
tion against  such  heroic  measures;  in  the  rebound  the  other 
extreme  was  reached,  even  to  practical  therapeutic  nihilism. 
Now,  instead' of  venesection  and  drastic  medication,  came 
tlie  theories  expounded  by  Hahnemann  (1753-1843),  which 
denied  disease,  admitting  only  symptoms.  This  apostle  of 
homoeopathy  was  the  son  of  a  porcelain-painter  in  Meissen; 
he  studied  in  Leipzig  and  in  Vienna,  and  later  practiced  in 
various  cities,  including  Dresden  and  Leipzig.  "  Similia 
similihus  curantur  "  was  not  original  with  him,  as  it  long 
before  had  been  formulated  by  Hippocrates,  and  later  by 
Paracelsus.  Of  the  life  and  labors  of  Hahnemann,  much 
might  be  told ;  but  this  is  not  the  time  or  place  to  go  into 
the  subject. 

An  offshoot  of  homoeopathy,  which  demands  only  the 
harshest  criticism,  is  Isopathy, — perhaps  the  filthiest  theory 
ever  invented, — according  to  which  like  is  to  be  cured  by 

16 


242 


THE    HISTORY   OF    MEDICINE. 


like,  and  to  sucli  an  extent  that  small-pox  is  to  be  treated 
by  variolous  pus,  tape-worm  by  the  ingestion  of  the  pro- 
glottides, etc. 

Another  of  the  rankest  of  fraudulent  outgrowths  is 
the  so-called  Electrohomoeopathic  system  of  Count  Mattei, 
who  prates  of  "red,"  "blue,"  and  "green"  electricity, — a 
theory  that,  in  spite  of  its  utter  idiocy,  has  attracted  a  con- 


FiG.  36.— Samuel  Hahnemann. 

(From  a  steel  engrariug.) 


siderable  following   and   earned   a  fortune   for  its   chief 
promoter. 

Another  of  the  vagaries  of  the  earlier  portion  of  the 
present  century,  and  that  still  survives,  in  a  weak  way,  is 
Cranioscopy,  or  Phrenology.  Gall  expoinided  his  doctrines 
at  Vienna  as  early  as  1796,  but.  being  expelled,  went  to 
Germany,  where  he  was  joined  by  Spurzheim,  who,  though 


BROUSSAIS.  243 

much  move  of  a  student  and  scientist,  accepted  the  docirine 
of  the  former  with  enthusiasm;  and  it  was  chiefly  due  to 
the  eftbits  of  Spuizheim  that  phrenology  was  introduced 
into  England,  and  later  (1832)  into  America.  Gall 
assumed  to  locate  twenty-seven  dift'erent  organs  alongside 
of  each  other  in  the  brain,  and  held  that  external  mark- 
ings on  the  skull  were  guides  to  the  development  of  the 
various  parts.  Every  neophyte  in  anatomy  knows  how 
little  foundation  there  is  for  such  a  doctrine,  but  for  a 
time  it  attracted  great  attention,  and  there  are  to-day 
certain  men  and  women  who  make  tlieir  living  out  of 
this  imposition. 

Tlie  Physiological  Theory  of  Medicine  was  originated 
by  Broussais  (1772-1838),  and  combined  the  views  of 
Pinel  and  Bichat  with  the  "sympathetic"  view  of  Hoff- 
mann, the  "concealed  inflammation"  of  Stoll,  and  the 
theory  of  inflammation  held  by  Marcus.  Broussais  had 
been  a  pupil  of  Bichat.  In  1814  he  began  hospital  teach- 
ing, and  in  1831  was  made  professor.  Personally  very 
vain,  quick-tempered,  even  belligerent,  as  a  therapeutist 
he  was  a  man  of  routine.  He  was,  perhaps,  best  known 
shortly  before  his  death,  wlien  delivering  lectures  on  phre- 
nology. According  to  him,  life  depends  upon  external 
irritation,  produced  by  heat,  which  excites  new  chemical 
processes,  while  these  in  turn  stimulate  regeneration, 
assimilation,  as  well  as  contractility,  and  sensibility. 
AVlien  the  functions  supported  by  heat  cease,  death  ensues. 
Healtli  depends  upon  moderate  action  of  external  irri- 
tants; disease,  upon  either  their  weakness  or  their  ex- 
traordinary strengtli.  He  saw  notliing  ontological  about 
disease.  In  therapeutics  he  admitted  the  healing  power 
of  Nature,  but  regarded  the  physician  not  as  a  minister, 
but  as  a  lord  of  Nature.  Febrile  and  inflammatory  dis- 
eases Avere  all  treated  by  the  withdrawal  of  nourislmient, 
carried  to  the  extreme.  His  most  powerful  antiphlogistic 
treatment  consisted  in  the  application  of  leeches   to  the 


244:  THE    HISTORY    OF    MEDICINE. 

abdomen,  and  to  robust  individuals  he  applied  from  thirty 
to  fifty  at  once  It  is  not,  then,  to  be  wondered  at  that, 
in  consequence  of  his  so-called  ''hirudinomania,"  leeches 
became  very  scarce  In  the  year  1833  forty-one  million 
five  hundred  thousand  leeches  were  im})orted  into  France, 
while  in  1824  one-twentieth  of  this  number  sufficed  to 
supply  the  demand.  Even  in  cases  of  worms,  the  abdom- 
inal integument  had  to  pay  its  blood- tribute,  particularly 
if  enteritis  prevailed.  He  only  allowed  a  spare  diet  of 
mucilaginous  and  acid  drinks.  In  mercurial  France  and 
Italy  he  gained  numerous  followers,  but  they  were  few 
and  far  between  in  practical,  hard-headed  Germany  and 
England.  His  best*  follower  was  Bouillaud  (1797-1881), 
who  adopted  the  symptomatic  nature  of  fever  and  the 
sanguinary  therapeutics  of  his  master,  but  used  the  lancet 
more  than  the  leech.  As  the  homceopaths  regard  Hahne- 
mann, so  Bouillaud  looked  up  to  Broussais  as  the  Messiah 
of  medicine  and  science,  which,  as  Baas  says,  were  "  already 
greatly  overstocked  with  Messiahs." 

Contemporaneous  with  the  school  of  Broussais,  and  its 
antagonist  in  all  respects,  was  the  Paris  School  of  Patho- 
logical Anatomy  and  Diagnosis,  which  has  given  tone  to 
all  medical  art.  It  made  it  the  duty  of  the  physician  to 
search  for  changes  in  the  human  body,  to  investigate  the 
local  products  of  disease,  and  assigned  to  medicine  the 
duty  of  removing  these  ]noducts.  Tlie  tendency  of  its 
teaching  was  to  treat  the  patient  rather  as  a  living  cadaver 
than  as  a  sentient  being  endowed  with  vital  forces,  and  the 
charge  which  Asclepiades  once  falsely  made  against  Hip- 
pocrates was  revived  upon  new  grounds.  Kratzmann  wrote 
some  years  ago:  "In  France  every  one  experiments  on  the 
sick,  less  to  attain  the  best  method  of  cure  than  to  enrich 
science  with  an  interesting  discovery  and  to  advance  the 
accuracy  of  diagnosis  by  some  new  physical  sign."  The 
seductiveness  of  this  system  promoted  still  more  one- 
sidedness,  which  finally  almost  attained  the  belief  that  the 


CRUVEILHIER.       ANDRAL,  245 

science  of  medicine  really  originated  in  tlie  Anatomical 
School  of  Paris. 

The  forerunners  of  this  school  were  Bichat  and  Pinel, 
and  its  proper  founders  were  Corvisart,  Dupuytren,  and 
Laennec.  There  was  also  Bayle,  who  was  first  to  apply 
the  ear  to  the  thorax  in  disease  of  tlie  heart,  and  thus 
became  the  predecessor  of  Laennec  and  Chomel.  He  was 
the  godfatlier  of  typhoid  fever,  and  from  being-  a  famous 
clinician  became  later  a  great  pathologist.  The  most  cele- 
brated adherent  of  the  metliod,  however,  was  Cruveilhier 
(1791-1873),  professor  first  in  Montpellier  and  then  in 
Paris,  who  revived  the  Anatomical  Society  founded  by 
Bichat,  and  wrote  his  first  essays  as  the  result  of  Dupuy- 
tren's  advice ;  finally,  there  came  from  his  pen  the  famous 
treatise  on  Pathological  Anafomt/,  with  its  magnificent 
plates, — a  work  begun  in  1830  and  not  fully  completed 
until  1864.  Like  Morgagni,  he  associated  general  and 
pathological  anatomy  with  bedside  observations  ;  also  es- 
tablished a  class  of  inflammations  to  which  belong  gan- 
grene and  atony,  and  a  certain  class  of  neuroses  and  fevers, 
and  endeavored  to  investigate  the  different  steps  in  the  de- 
velopment of  lesions,  not  simply  their  final  products.  His 
teachings  concerning  pyaemia  and  phlebitis,  which  had 
been  first  studied  by  John  Hunter,  excited  great  attention, 
and  he  even  came  to  the  one-sided  conclusion  that  "  phle- 
bitis rules  the  whole  of  pathology."  He  was  the  first  to 
observe  that  its  suppurative  form  does  not  occur  primarily, 
but  is  secondary  to  coagulation  of  the  blood. 

The  ablest  representative  of  this  school,  and  one  who, 
perhaps,  more  than  any  other  man,  made  Paris  a  Mecca 
to  which  foreigners  made  their  pilgrimages,  was  Andral 
(1797-1876), — the  son  of  a  physician  and  the  most  noted 
and  indefatigable  investigator  and  thinker  of  his  time. 
Between  1823  and  1840  were  published  the  five  volumes 
of  his  Medical  Clinic,  which  made  him  famous.  He 
taught,  in  opposition  to  Broussais,  the  existence  of  primary 


246  THE    HISTORY    OF    MEDICINE. 

diseases  of  tlie  blood,  tlie  so-called  dyscrasise ;  made  phys- 
iology subservient  to  pathology ;  was  tlie  creator  of  the 
chemistry  of  the  blood ;  and  in  therapeutics  was  wedded 
to  emetics  and  cathartics,  ascribing  little  importance  to 
abstraction  of  blood. 

The  first  man  to  apply  the  Numerical  Method  to 
pathology,  and  who  brought  about  the  downfall  of  Brous- 
sais,  was  Louis  (1787-1872),  who  had  studied  in  Russia, 
but  came  to  Paris  while  still  a  young  man.  He  expressed 
his  principle  in  the  following  words:  "As  often  as  I  have 
formed  an  a  'priori  idea  and  had  afterward  opportunity  to 
prove  the  facts,  I  have  invariably  found  that  my  idea  was 
false.  In  patliology  as  well  as  in  therapeutics  numerical 
analysis  is  a  useful  practice.  By  numbers  only  can  be  ob- 
tained the  frequency  of  conditions  or  this  or  that  symptom  ; 
by  a  definite  enumeration  alone  is  it  possible  to  utilize  the 
special  relations  of  age,  sex,  constitution  of  our  patients, 
to  settle  tliat  this  or  that  symptom  occurs  so  often  in  one 
hundred  or  one  thousand  cases."  This  system  he  applied 
to  etiology,  symptomatology,  prognosis,  therapeutics,  and 
pathological  anatomy.  He  discarded  blisters  and  con- 
demned large  bleedings,  but  fell  into  other  errors,  carrying 
his  numerical  method  to  an  unjustifiable  extreme. 

Next  to  Andral  and  Louis  should  be  mentioned 
Magendie  (1783-1855),  Professor  of  General  Pathology 
in  the  College  de  France,  and  physician  to  the  Hotel-Dieu, 
who  was  a  representative  of  the  new  French  medicine,  and 
introduced  experiments  into  both  pathology  nnd  physi- 
ology ;  he  was  the  pioneer  in  experimental  pharmaco- 
dynamics, which  occupies  itself  largely  with  alkalies,  a 
large  number  of  which  he  introduced  into  practice.  He 
was  a  solid  humoralist  in  pathology,  a  most  accurate  diag- 
nostician, but  (it  is  charged)  "  was  too  simple  in  thera- 
peutics"! As  a  result  of  his  intravenous  injections  of 
putrefactive  material,  he  had  the  terms  "pyaemia,"  "  ichor- 
rhaemia,"  and  "metastasis"  introduced  into  pathology. 


TROUSSEAU.   CLAUDE  BERNARD.  247 

Trousseau  (1801-1866),  of  Tours,  also  became  professor 
in  the  Paris  Faculty,  and  rendered  especial  service  in  his 
studies  of  croup  and  the  employment  therefor  of  trache- 
otomy, though  his  chief  fame  rests  upon  his  merit  as  a 
clinical  teacher  and  the  publication  of  clinical  lectures 
which  are  still  models  in  every  way  of  accurate,  forcible 
teaching. 

Claude  Bernard  (1813-1878)  became  the  successor  of 
Magendie,  and  even  more  famous  as  an  experimenter  in 
pathology,  physiology,  and  anatomy.  Originally  a  poet,  he 
finally  turned  to  medicine  and  science,  and  in  1869  hecame 
a  member  of  the  French  Academy. 

One  of  the  results  of  the  French  fondness  for  patho- 
logical anatomy  was  an  outgrowth,  unfortunate  in  some 
respects,  of  specialism,  which  made  its  appearance  early 
and  spread  to  other  countries,  particularly  to  Germany,  so 
that  to-day  there  is  scarcely  an  organ  in  the  body  which 
has  not  only  its  special  student,  but  its  special  represen- 
tative in  medicine.  It  would  be  of  interest  to  go  over  some 
of  the  various  organs  and  count  those  who  have  become 
most  renowned  in  the  study  of  their  diseases,  but  that  is 
beyond  the  scope  of  this  volume. 

As  Baas  says,  England,  after  her  excessive  participation 
in  the  iatrochcmistry  and  iatromechanics  of  the  seven- 
teenth century,  with  a  devotion  that  extended  far  into  the 
eighteenth,  seemed  then  to  lose  all  confidence  in  systems 
and  schools  of  medicine,  inasmuch  as  since  that  time  no 
system  or  so-called  .school  has  gained  in  Great  Britain  any 
large  or  permanent  band  of  followers ;  even  Brunonianism 
did  not  succeed  in  this  respect.  This  form  of  conservatism 
is  a  characteristic  of  the  British  race.  But  while  schools 
have  not  risen,  individuals  have  formulated  hypotheses 
or  doctrines  that  at  least  attracted  attention,  if  not  fol- 
lowers. For  instance,  John  Mason  Goode  (1764-1827) 
formulated  an  intricate  nosological  arrangement  in  his 
long-popular   text-book    entitled    The  Study  of   Medicine^ 


248  THE    HISTORY    OF    MEDICINE. 

and  also  arranged  a  classification  of  diseases  now  almost 
forgotten. 

In  1816  Sir  Charles  Bell  (1774-1842)  made  the  mem- 
orable discovery  that  the  posterior  roots  of  the  spinal  nerves 
preside  over  sensation,  and  the  anterior  over  motion;  and 
this  attracted  anew  the  attention  of  English  physicians  to 
the  nervons  system,  and  was  rewarded  by  the  later  discovery 
of  reflex  action  or  reflex  phenomena,  communicated  to  the 
Royal  Society  in  1863  by  Marshall  Hall.  Both  discoveries 
were  important,  and  both  were  dnly  rewarded  by  yet 
others. 

Benjamin  Travers  (1783-1858)  seems  to  have  been 
greatly  influenced  by  the  first  of  these  discoveries,  and  led 
thereby  to  pay  special  attention  to  what  he  termed  "  con- 
stitutional irritation  ";  his  studies  on  this  subject  are  oflen 
quoted  to-day,  and  are  well  worthy  of  perusal ;  he  under- 
stood by  this  term  a  process  (in  strong  contrast  with  inflam- 
mation) which  subsides  without  hyperaemia  and  without 
plastic  exudate,  but  whicli,  on  the  other  hand,  may  occasion 
liquid  products  and  result  in  neoplasms. 

Contemporaries  of  Travers  were  :  Abram  Colles ;  John 
Cheyne  (1777-1830),-  of  Dublin,  who  wrote  on  Diseases 
of  Children  and  described  "  Cheyne-Stokes  respiration  "; 
William  Stokes  (1804-1878),  also  of  Dublin,  who  distin- 
guished himself  in  1857  by  a  great  work,  entitled  A 
Treatise  on  the  Diagnosis  and  Treatment  of  Diseases  of 
the  Chest  ;  Robert  Graves  (1797-1853),  Professor  of 
Medicine  in  the  King's  and  Queen's  College,  Dublin,  who 
published  clhiical  lectures  of  his  own,  besides  many  clinical 
reports  in  connection  with  Stokes.  Graves  was  one  of  the 
first  to  oppose  the  "  absolute  diet"  of  the  earlier  physicians 
in  the  management  of  febrile  maladies,  and  requested  that 
his  epitaph  should  have  but  one  line — "  He  fed  fevers ! " 

"  The  School  of  Natural  Philosophy "  was  the  title 
applied  to  a  system  which,  in  Germany,  ran  parallel  with 
that  of  Broussais,   being    the    legitimate   outcome    of  the 


THE    SCHOOL   OF   NATURAL   PHILOSOPHY.  249 

medical  pliilosophy  of  the  eighteenth  century  which  had 
originated  there,  and  also  a  revival  of  opposition  thereto  on 
the  side  of  realism.  It  led  into  speculative  extremes,  which 
finally  sobered  down,  because  of  the  meaningless  scholastic 
phrases  often  introduced,  and  thus  broke  a  path  for  the 
subsequent  enthusiasm  in  behalf  of  French  positivism  in 
medicine.  Those  who  constituted  this  school  were,  for  the 
most  part,  men  of  importance,  but  were  followed  by  a 
number  of  imbecile  representatives.  Use  was  made  of  the 
abstract  doctrine  of  the  philosophy  of  identity  and  the 
imponderables,  such  as  electricity,  mechanical  forces,  and 
magnetism,  contrasted  with  which  were  the  dimensions  of 
matter  and  certain  qualities,  like  sensibility,  irritability,  etc. 
Perhaps  the  greatest  influence  of  this  teaching  was  in  the 
department  of  embryology  and  physiology,  where  Johannes 
Miiller  displayed  his  remarkable  activity.  Among  the  most 
distinguished  representatives  of  the  natural-philosophy 
school  was  Oken  (1779-1851),  of  Bavaria,  who  subse- 
quently taught  in  Munich,  Jena,  and  Zurich,  and  published 
a  large  work  on  natural  history,  which  did  much  for  the 
popularization  of  this  science  ;  he  explained  that  the  skull 
is  made  up  from  a  series  of  vertebrae ;  also  discovered  the 
Wolffian  bodies,  and  was  such  a  power  in  his  way  that 
Agassiz  characterized  him  not' only  as  "a  master  in  the  art 
of  teaching,"  but  as  "a  courageous  and  ruling  spirit." 
Others  of  this  school  were:  von  Walther  (1782-1849), 
eminent  as  a  surgeon;  Dollinger  (1770-1841),  of  Bam- 
berg, the  distinguished  leader  of  the  Old  Catholics;  Reil 
and  Prochaska,  anatomists  ;  Troxler  and  Schelling,  philos- 
ophers and  anatomists ;  Treviranus,  the  microscopist ; 
Malfatti,  Kilian,Spindler;  Schmidt,  of  Vienna ;  and  others 
too  numerous  to  mention. 

As  a  successor  to  the  School  of  Natural  Philosophy 
came  the  School  of  Natural  History  (1831-1850),  which 
made  important  concessions  to  realism  ;  its  most  prominent 
members  were  from   South   Germany.     This  school  was 


250  THE    HISTORY    OF    MEDICINE. 

based  partially  upon  the  philosophy  of  Nature,  and  expired 
almost  suddenly.  One  of  its  most  eminent  exponents  was 
Knikenberg,  whose  therapeutic  creed  was  that  "  Physicians 
should  be  filled  with  pious  reverence  toward  Nature ;  the 
organism  is  a  whole,  and  must  be  contemplated  in  this 
sense ;  medical  art  is,  undoubtedly,  capable  of  decisive 
action,  but  let  us  not  mistake  that  in  many  cases  its 
activity  is  quite  superfluous,  in  very  many  null  and  inade- 
quate, and  in  many  injurious."  This  school  was  the 
expression  of  the  turn  medicine  was  compelled  to  take 
in  order  to  escape  the  after-effects  of  the  one-sided,  ideal, 
systematizing  tendency  of  the  eighteenth  century  (whose 
final  outcome  was  natural  philosophy),  and  to  square  itself 
with  the  realism  and  positivism  of  the  nineteenth. 

Schonlein  (1763-1874),  of  Bamberg,  outlined  a  system 
that  taught  pathological  and  anatomical  revelations  as  con- 
crete expressions  of  the  independent  entity  disease,  whose 
relation  to  the  organism  is  as  that  of  a  parasite  sojourning 
temporarily  in  it;  he  also  constructed  a  classification  of 
diseases,  something  after  the  manner  of  the  botanical 
classification  of  de  Candolle.  One  of  his  best-known 
pupils  was  Canstadt  (1807-1850),  whose  JahreshericJit  has 
preserved  his  name.  Siebert,  of  Jena,  famous  as  a  diag- 
nostician, and  Haeser,  the  medical  historian,  belonged  to 
this  school. 

An  off'shoot  of  the  French  school  of  pathological 
anatomy  and  diagnosis  was  the  so-called  New  Vienna 
School,  which  aided  the  French  system  in  obtaining  high 
recognition  in  German  medicine,  and  gained  its  first 
influence  from  the  labors  of  Wunderlich  (1815-1857); 
next  to  whom  should  be  mentioned  Baron  von  llokitansky 
(1804-1878), — a  Bohemian, — one  of  the  most  famous  men 
in  modern  times,  and  who  exercised  a  profound  influence, 
even  in  foreign  countries, — particularly  in  Italy  and  Russia. 
Von  Rokitansky  worked  for  a  long  time  in  miserable 
quarters   in  Vienna,  but   finally  a    magnificent    building 


ROKITANSKY.       THE    NEW    VIENNA    SCHOOL.  251 

was  specially  erected  for  liim.  He  was  loaded  with  honors, 
and  took  his  seat  in  the  Austrian  House  of  Deputies.  Two 
sons  are  well  known  in  medicine  to-day,  and  two  more 
have  achieved  re[)utation  as  singers, — a  circumstance  which 
the  father  embodied  in  the  hon  mot  that  "two  of  his  sons 
liowled  and  two  of  them  healed."  He  transplanted  into 
Vienna  the  tendency  of  the  earliest  pathologico-anatomical 
school,  which  captivated  all  by  its  novelty  and  interest,  and 
in  the  post-mortem  room  and  the  clinical-lecture  room  he 
converted  medicine  in  Germany  to  the  realism  of  the  nine- 
teenth century.  He  was,  indeed,  the  Van  Swieten  of  his 
time  in  his  influence  upon  educational  affairs.  His  works 
are  distinguished  by  simplicity,  clearness,  and  logical  order. 
He  performed  more  than  thirty  thousand  autopsies;  for 
fourteen  years  he  studied  the  defects  of  the  septum  of  the 
heart  and  the  comparative  anatomy  of  the  uterus  and 
genito-urinary  organs,  yet  paid  little  attention  to  the  micro- 
scope or  to  applied  medicine.  He  was  a  pathologist,  pure 
and  simple. 

A  friend  and  co-laborer, — Skoda  (1803-1881), — also  a 
Bohemian,  was  little,  if  any,  less  famous.  In  1839  he 
gave  to  the  world  his  famous  work  on  Auscultation  and 
Permission  y  in  1847  became  professor  at  Prague,  and  was 
the  first  man  to  lecture  in  German.  In  spite  of  his  bach- 
elor pecidiarities,  his  taciturn-ity,  and  his  heedlessness,  he 
was  very  popular,  and  left  a  fortune, — quite  in  contrast  to 
Rokitansky,  who  died  poor.  His  scientific  merit  was  based 
upon  the  fact  that  he  overthrew  the  specific  and  pathogno- 
monic arrangement  of  sounds,  as  taught  by  the  French, 
and  substituted  therefor  a  category,  based  upon  the  physical 
constitution  and  shape  of  organs  and  tissues.  He  endeav- 
ored to  develop  a  strictly  scientific  system  of  physics  out 
of  the  empirical  French  doctrine  of  physical  signs,  and  in 
liis  work  on  Physical  Diagnosis  he  displayed  an  inde})endent 
spirit,  though  as  one  who  had  received  his  impulse  from 
France.     He  was  the  first  in  Germany  to  insist  upon  the 


252  THE    HISTORY    OF    MEDICINE. 

merits  of  Avenbrugger,  and  was  the  leading  diagnostician 
of  his  time  of  the  new  Vienna  school.  Skoda  was  the  first 
for  whom  was  created,  in  Vienna,  a  specialty  after  the 
French  model, — that  is,  a  special  division  for  patients  suffer- 
ing from  thoracic  diseases.  Great  as  he  was,  we  must  yet 
lay  it  up  against  him  that  tlirough  his  influence, — first  in 
A^'ienna  and  afterward  thronghout  Germany, — practical 
medicine  degenerated  into  simple  diagnosis,  and  that,  by 
his  observations  on  the  natural  course  of  disease,  undis- 
turbed by  therapeutics,  he  became  the  founder  and  exponent 
of  expectant  or  nihilistic  therapeutics, — the  harbinger  of  a 
very  cheerless  period  in  the  history  of  medicine. 


CHAPTER  X. 

Age  of  Renovation  {comludeil).—N€w  Vienna  School  {concluded) :  von  Hebra, 
1816-1880.  Czerniak  and  Tiirck,  Jiiger,  Arlt,  Gruber,  Folitzer.— German 
School  of  riujsioloyical  Medicine:  Roser,  1817-1888.— ,SWtooi  of  Rational  Med- 
icine:   Heiile,  1809-1855.— PseMdoiJarace/s/sm  .•    Ratlemacber,   1772-1849. 

Hydrotherupeuticn :  Priessiiitz,  1799-1852.— 3/oc?er«  Vitalism :  Virchow. — 
Seminalisni :  Bouchut. — Farasitism  and  the  Germ-theory:  Davaine,  1811- 
1882.  Pasteur,  1822-1895.  Chauveau,  1827—.  Klebs,  1834—.  F.  J. 
Cohn,  1828—.  Koch,  1843—.  Lister,  1827— .—^rfraHces  in  Physical  Diag- 
nosis :  Laeniiec,  1781-182(J.  Piony,  1794-1879. — Surgery  :  Delpech, 
1772-1832.  Stromeyer,  r804-1876.  Sims,  1813-1883.  Bozenian,  1825—. 
McDowell,  1771-1830.  Boyer,  1757-1853.  Larrey,  1766-1842.  Dupiiy- 
tren,  1777-1835.  Cloquet,  1790-1883.  Civiale,  1792-1867.  Vidal,  1803- 
1856.  Yelpeau,  1795-1868.  Malgaigne,  1806-1865.  Nelaton,  1807-1874. 
Sir  Astley  Cooper,  1748-1841.  Brodie,  1783-1862.  Guthrie,  1785-1856. 
Syme,  1799-1870.  Simpson,  1811-1870.  Langenbeck,  1810-1887.  Bill- 
roth, 1819-1894. 

A  FEW  of  Skoda's  more  eminent  colleagues  deserve 
brief  mention  :  Oppolzer  (1808-1871)  was  singularly  gifted 
in  diagnosis,  popular,  a  teacher  of  wide  influence,  and 
manifested  in  superlative  degree  the  characteristics  that 
constitute  a  great  physician  ;  he  wrote  little,  but  was  for  a 
long  time  Professor  of  Medicine  at  Prague.  Von  Hebra, 
the  elder  (1816-1880),  worked  a  complete  revolution  in 
dermatology,  and  developed  a  classification  based  upon  the 
pathological  anatomy  of  the  skin.  He  instituted  a  new 
and  independent  line  of  therapeutics  as  applied  to  this 
branch  of  our  art,  for  which  the  medical  world  will  ever 
hold  him  in  grateful  remembrance.  Sigmund  and  Zeissl 
during  the  same  period  did  much  to  clear  up  the  problems 
of  syphilis.  To  Czermak  (1828-1873)  and  Tiirck  (1807- 
1868)  we  are  indebted  (practically)  for  the  making  a 
specialty  of  diseases  of  the  nose  and  larynx  ;  of  like  serv- 
ice to  ophthalmology  were  Jiiger,  Graefe,  Arlt,  Stellwag, 
Donders,  Hasner,  Mauthner,  Fuchs,  aijd  von  Reuss,  while 
Gruber  and  Politzer  did  as  much  lor  diseases  of  the  ear. 

An  indirect  offshoot  of  the  new  Vienna  school  is  the 
so-called    "  Physiological    Medicine,"    founded    by    Roser 

(253) 


254  THE    HISTORY    OF    MEDICINE. 

(1817-1888),  of  Stuttgart  (late  Professor  of  Surgery  in 
Marburg),  seconded  by  Griesinger  and  Wunderlicli.  Their 
views  were  directed  against  the  symptomatologists  and 
idealists,  and  particularly  against  the  School  of  Natural 
History,  the  claim  being  that  physiology  must  include  vital 
phenomena,  while  from  the  morbid  portions  of  these  phe- 
nomena the  special  science  should  be  formed  as  an  artificial, 
yet  practical,  division  of  knowledge.  Wunderlich's  book 
of  therapeutics  was  for  a  long  time  the  best  guide  in  this 
direction,  inasmuch  as  it  left  to  individual  thouglit  and 
judgment — the  Hippocratic  method  of  investigation — the 
determination  of  value  and  demand.  Another  oflshoot, 
that  differs  but  little  from  this  save  in  definition,  is  the 
"  School  of  Rational  Medicine,"  originated  by  Pfeufer 
(1806-1869)  and  Henle  (1809-1855),  and  which,  since 
1841,  has  been  represented  by  a  special  journal.  While 
Wiinderlich  claimed  pathology  to  be  the  physiology  of  the 
sick,  Henle  considered  this  questionable  and  made  no  dis- 
tinction at  all  between  the  physiology  of  tlie  healthy  and 
that  of  the  ill.  The  language  of  the  followers  of  this 
school  contrasted  strongly  with  that  emanating  from  other 
schools,  and  for  a  time  was  confident  and  ingeniously 
triumphant;  nevertheless,  it  did  not  forget  philosophical 
speculation,  and  Hegel  may  now  be  regarded  as  indirectly 
the  godfather  of  rational  medicine. 

The  vagaries  of  Paracelsus  led  indirectly,  though  posi- 
tively, to  the  foundation  of  Homoeopathy,  and  likewise 
originated  the  doctrine  that  bears  the  name  of  Rademacher 
(1772-1849).  It  is  curious  that  this  pseudoparacelsic 
system  should  spring  up  alongside  of  the  Vienna  school, 
its  teachings  being  the  classification  of  diseases  by  their 
therapy.  Rademacher's  followers  possessed  three  universal 
remedies, — "  cubic  niter  (nitrate  of  sodium),  copper,  and 
iron," — and  also  three  primary  diseases  that  must  take 
their  titles  from  the  three  universal  medicaments.  In  sj)ite 
of  the  admission  that  these  diseases  were  unknown,  it  was 


MODERN    VITALISM.  255 

boldly  asserted  they  were  with  certamty  to  be  cured  by  the 
tliree  chief  remedies.  The  three  piimary  diseases,  "  sodic 
nitrate,  copper,  and  iron  diseases,"  do  not  necessarily 
remain  as  sucli,  as  they  may  throw  some  organ  "into  a 
condition  of  sympathy,  and  thus  it  results  that  iron  disease 
may  express  itself  in  the  form  of  consumption,  delirium 
tremens,  etc.,  while  a  copper  disease  may  appear  as  worms, 
paralysis,  jaundice,  etc."  Besides  universal  diseases  and 
universal  remedies  there  were  diseases  of  organs,  to  be 
diagnosed  by  the  efficacy  of  organ  remedies ;  thus,  abdom- 
inal diseases  must  be  relieved  by  corresponding  "  abdom- 
inal remedies,"  head  diseases  with  "head  remedies,"  chest 
diseases  with  "chest  remedies,"  etc.  Also  for  each  partic- 
ular viscus  there  must  be  a  special  remedy.  What  is  the 
most  surprising  about  this  absurd  doctrine  is  that  it  found 
followers,  some  even  quite  capable  in  their  way. 

Now,  too,  reappeared  the  Hydrotherapeutic  System — 
the  great  apostle  of  which  was  Priessnitz  (1799-1852) — 
based  upon  gross  views  of  humoral  pathology,  according  to 
which  a  disease  entity  was  to  be  expelled  in  the  form  of 
sweat,  eruption,  etc.  Poultices,  cold  packs,  and  cold  baths 
were  the  principal  therapeutic  measures.  Winternitz  has 
made  hydrotherapy  popular  and,  in  a  measure,  effective  in 
the  management  of  certain  maladies. 

Rudolph  Virchow  in  1858  instituted  the  doctrine  or 
theory  known  as  "  Modern  Vitalism,"  which,  in  fact,  was 
borrowed  from  natural  scientific  medicine,  and  distin- 
guished from  the  vitalism  of  the  previous  century  in  that 
it  breaks  up  the  old  vital  force,  which  was  supposed  to  be 
either  distributed  throughout  the  entire  body  or  located  in 
a  few  organs,  into  an  indefinite  number  of  associate  vital 
forces  working  harmoniously,  and  assigns  to  them  all 
tlie  final  elementary  principles  without  microscopic  seat. 
"  Every  animal  principle  has  a  sum  of  vital  unities,  each 
of  which  bears  all  the  characteristics  of  life.  The  char- 
acteristics and  unity  of  life  cannot  be  found  in  any  deter- 


256  THE    HISTORY   OF   MEDICINE. 

minate  point  of  a  higher  oigauism, — e.g.,  in  the  brain, — 
but  only  in  the  definite,  ever-recurring  arrangement  of  each 
element  present ;  hence  it  results  that  the  composition  of  a 
large  body  amounts  to  a  kind  of  social  arrangement,  in 
which  each  one  of  the  movements  of  individual  existence 
is  dependent  upon  the  others,  but  in  such  a  way  that  each 
element  has  a  special  activity  of  its  own,  and  that  each, 
although  it  receives  the  impulse  to  its  own  activity  from 
other  parts,  still  itself  performs  its  own  functions,"  This 
is  nothing  but  another  way  of  expressing  the  cell-doctrine, 
to  which  many  medical  men  are  now  committed,  which 
means  that  all  bodies  are  built  up  of  cells  and  that  each 
cell  has  a  unity  and  a  purpose  of  its  own. 

In  1677  Sir  Robert  Hooke  discovered  plant-cells;  later 
Schwann  discovered  animal  cells  and  Robert  Brown  cell- 
nuclei  ;  but  it  remained  for  Yirchow  to  supply  the  gap 
which  had  risen  between  anatomical  knowledge  and  med- 
ical theory  ;  that  is,  to  supply  a  "cellular  pathology,"  since 
which  time  the  cell  has  assumed  the  role  which  the  fibre 
occupied  in  the  theories  of  the  seventeenth  and  eighteenth 
centuries.  Time  alone  can  decide  as  to  tlie  ultimate 
validity  of  this  theory,  which  has  in  certain  circles  been 
most  enthusiastically  received.  One  of  its  weakest  aspects 
is,  perhaps,  that  the  so-called  intercellular  substance  plays 
an  uncertain  and  unsatisfactory  part.  An  important  feature 
in  which  the  cellular  pathology  differs  from  other  systems, 
and  particularly  from  the  old  humoral  pathology,  is  in  the 
doctrine  that  the  blood  itself  is  not  the  proper  and  original 
cause  of  dyscrasiae,  and  probably  not  the  cause  of  contin- 
uous alteration  of  the  tissues  ;  that  these  dyscrasiae  arise 
because  the  blood  is  not  an  independent  structure,  but 
dependent  upon  the  condition  of  the  patient  in  consequence 
of  its  continuous  conveyance  of  the  noxious  material  from 
all  parts  of  the  body, — the  blood  is,  therefore,  merely  the 
medium  for  the  production  of  the  dyscrasia.  This  theory 
has  made  several  peculiar,  new,  and  symptomatic  or  mor- 


RUDOLPH    VIRCHOW. 


257 


phological  forms  of  disease,  such  as  leukaemia,  leucocytosis, 
etc.  Virchow  also  cleared  up  the  old  and  obscure  ideas 
regarding  pyaemia,  and  proved  that  an  absorption  of  pus 
into  the  blood,  which  the  name  implies,  is  quite  impossi- 
ble; likewise,  that  pyaemia  is  inseparable  from  thrombotic 
processes. 

Virchow  was  born  in  Pomerania  in  1821,  and  in  1849 


Fig.  37.— Rudolph  ViRCHO\r. 


distinguished  himself  by  attaining  the  highest  grade  in  the 
career  of  the  learned, — a  professorship,  which  he  first  held 
in  Wiirzburg.  During  earlier  years  his  residence  and 
labors  were  largely  the  result  of  necessities  arising  from 
political  views,  for  on  account  of  these  he  was  long  denied 
a  residence  in  Berlin.  A  personal  friend,  now  old,  once 
an  interne  in  the  great  Julius  Spital,  in  Wiirzburg,  at  the 


258  THE    HISTORY    OF    MEDICINE. 

time  when  Yirchow  tauglit  there,  tells  me  a  light  was 
burning  every  night  in  Virchow's  room  until  3  a.m.,  and 
yet  the  professor  was  always  out  at  work  by  7.  It  was  by 
such  intense  application  that  he  arrived  at  his  present 
position  at  the  very  top  of  the  professional  ladder ;  but 
very  few  men  have  the  physique  and  constitution  to  stand 
such  arduous  study.  In  1856  he  assumed  the  chair  of 
Pathological  Anatomy  in  Berlin,  and  introduced  micro- 
scopical anatomy,  to  which  Rokitansky  had  not  given  suffi- 
cient attention.  Virchow  was  a  former  pupil  of  Johannes 
Miiller,  famous  as  a  physiologist  and  pathologist,  and  his 
views  to-day  are  often  tinged  by  the  doctrines  acquired 
from  this  great  teacher.  He  is  also  a  great  admirer  of 
Harvey,  whose  picture,  at  least  for  a  long  time,  was  the 
only  one  permitted  to  hang  in  his  study.  His  first  edition 
of  Cellular  PatJioJog//  appeared  in  1858;  the  colossal 
work  on  Tumors  in  1866,  in  which  he  carried  out  the 
division  of  morbid  growths  priginally  adopted  by  Johannes 
Miiller  in  1838,  classifying  them  according  to  tlieir  micro- 
scopical elements.  He  is  also  scarcely  more  celebrated  for 
his  teachings  and  labors  than  for  the  number  of  famous 
pupils  brought  up  under  his  influence,  among  whom  may 
be  mentioned  Leyden,  Recklinghausen,  Cohnheim,  Wal- 
deyer,  Kiihne,  and  Rindfleisch.  As  a  result  of  his  labors 
has  arisen  in  Germany  what  has  been  called  the  "  Medical 
School  of  Natural  Sciences,"  that  seeks,  by  means  of 
pathological  anatomy  and  microscopy,  experimental  phys- 
iology and  pathology,  and  the  other  applied  methods,  to 
make  of  medicine  an  exact  science ;  and  to  it  belong 
such  men  as  Ziemssen,  Gerhardt,  Nothnagel,  Liebermeis- 
ter.  Senator,  Erb,  Vogel,  and  others.  An  offshoot  from 
this  is  the  so-called  "  Munich  Clinical  School,"  to  which 
belong  von  B'.ihl.  Pettenkofer,  Seitz,  and  Oertel. 

The  splitting  up  of  medicine  into  specialties,  and  the 
increase  of  its  subordinate  branches  into  schools, — so  called, 
— resulted  in  great  danger  to  the  unity  of  medical  science. 


BOUCHUT    AND    SEMINALISM.  259 

A  return  to  the  methods  which  combine  science  and  prac- 
tice— the  so-called  chnical-practical  method — is  again 
sought  by  men  who  have  estabUshed  tlie  well-known 
Zeltsclirift  fur  KUnische  3Iedicin,  under  the  management 
of  Frerichs  and  Leyden, — a  journal  which  has  already 
done  a  great  deal  of  good. 

The  versatile  Bouchut,  of  Paris,  has  recently  published 
a  theory, — the  so-called  "  Seminalism," — for  which  the 
claim  is  made  tliat  he  grants  nothing  to  hypothesis,  and 
everything  to  observation ;  its  cliaracteristic  is  that  this 
new  theory  is  also  vitalistic, — in  fact,  the  French  have 
scarcely  ever  brought  forth  any  other  than  vitalistic  theories. 
Bordeu  and  Barthez,  during  the  previous  century,  created 
the  first  French  theory,  which  was  followed  out  by  Bichat, 
and  later  by  Bouchut,  who,  as  a  matter  of  fact,  owes  much 
to  Bichat.  Bouchut  teaches  that  beasts  have  an  intelli- 
gence of  instinct,  and  men  one  of  abstraction  ;  no  beast 
oversteps  the  limits  of  animal  thought,  wliich  is  separated 
by  an  abyss  from  the  productive  thought  of  men  ;  there  is 
a  proper  kingdom  of  man,  in  accordance  with  his  special 
nature  ;  also,  that  tlie  vital  forces  of  men  and  of  beasts  are 
entirely  different  from  each  other,  and  that  the  principle  of 
physical  identity  remains  in  the  bodies  of  each,  since  the 
constantly  renewed  mass  is  formed  in  exact  accordance 
with  the  original  plans ;  in  all  the  changes  of  his  elements 
man  is  identical  with  man  ;  all  internal  and  external  causes 
of  disease  modify,  more  or  less,  the  vital  force  and  its 
impressibility  in  the  fluids  or  at  some  point  in  the  economy, 
eitlicr  increasing  it  or  diminishing  it.  This  theory,  pub- 
lished in  1873,  claimed  "in  the  abstraction  of  its  promise 
and  completeness  of  its  conclusions  to  yield  to  none  of  its 
predecessors."  Yet,  even  in  France,  the  task  of  transform- 
ino-  medicine  into  a  natural  and  exact  science  is  far  from 
being  a  fait  accomjM. 

The  most  recent  theories  of  disease  are  the  result  of 
microscopical  study  of  germs, — the  germ-tlieory,  in  fact, — 


260  THE    HISTORY    OF    MEDICINE. 

and  stand  in  the  closest  possible  relation  with  the  doctrine 
of  spontaneous  generation,  fermentation,  miasm,  and  con- 
tagion. In  1838  Ehrenberg  regarded  infusoria  as  animals, 
but  Dujardin  in  18-41  expressed  doubts,  and  Perty  in  1852 
affirmed  that  most  forms  classified  as  infusoria  should  be 
assigned  to  the  vegetable  kingdom,  where,  a  little  later, 
Naegeli  relegated  them.  The  correctness  of  this  conclusion 
was  proved  by  Colin,  who  also  perfected  a  classification. 
This  particular  form  of  investigation  began  in  the  twenties 
of  the  present  century  and  assumed  its  present  direction  in 
the  thirties  and  forties.  Gaspard,  in  1823,  renewed  the 
experiments  of  Haller,  and  injected  into  the  veins  of 
animals,  not  alone  putrescent  material,  but  the  blood  of 
other  creatures  suffering  from  the  effect  of  such  injections. 
Bassi.  in  1835,  discovered  the  cause  of  silk- worm  disease, 
thereby  giving  special  impulse  to  the  theory  of  parasitism, 
and  this  was  quickly  followed  by  evidence  of  the  existence 
of  both  vegetable  and  animal  exciters  of  disease.  Schoenlein, 
in  1839,  demonstrated  the  fungus  of  favus ;  Vogel  discov- 
ered the  O'idiam  albicans  in  1840;  Goodsir,  the  Sarcina 
ventricuU,  in  1841  ;  but  the  greatest  influence  upon  the 
development  of  the  parasitic,  or  germ-theory  was  the 
sequel  to  the  discovery  of  the  anthrax  bacillus,  by  Uavaine 
in  1850.  In  1837  Latour  and  Schwann  demonstrated 
that  the  cells,  which  were  known  even  to  Leeuwenhoeck, 
were  actually  vegetable  forms,  and  Schulze  had  already 
pointed  out  that  fermentation  of  fluids  could  only  occur 
in  the  presence  of  extremely  minute  vegetable  organisms; 
Chevreul  next  showed  that  animal  solids  remained  I'ilc 
from  decomposition  when  protected  from  the  access  of 
germs;  and  in  1857  Pasteur  demonstrated  that  fermenta- 
tion and  putl'efaction  were  caused,  not  by  chemical  forms, 
as  Liebig  had  taught,  but  simply  by  the  agency  of  lower 
organisms,  which  he  divided  into  aerobes  and  anaerobes; 
while  in  1868  Chauveau  queried  as  to  whether  morbific  ele- 
ments resided  in  the  formed  elements  of  germs  or  in  their 


THE   GERM-THEORY    OF   DISEASE.  261 

fluid  constituents.  Thus  the  theory  of  contaglum  viviim,  for 
which  Henle  contended  as  early  as  1821,  was  not  forgotten. 
In  Germany  Klebs  and  Hueter  became  the  prominent 
champions  of  this  theory;  HaUier  had  designated  his  so- 
called  "  Mlcrosporon  sej^>ticuni,'"  and  introduced  a  method  of 
fractional  cultures.  The  views  of  Klebs  were  opposed  by 
Billrotli,  who  contended  for  his  "phlogistic  ferment"  and 
'^  Coccohacteria  septica,^^  upon  which  he  wrote  an  elaborate 
and  extensively  illustrated  treatise ;  he  also  at  that  time 
opposed  the  specific  character  of  the  lower  organisms  as 
disease  agents.  Hallier's  nricrosporon  was  refuted  by  Cohn, 
who  studied  and  classified  the  various  fungi,  and  distin- 
guished between  the  pathogenic  and  the  septicogenic, — 
that  is,  those  which  produced  disease  and  those  which  pro- 
duced ordinary  putrefaction.  Then  came  the  experimental 
evidence  of  Davaine  and  Koch,  who  demonstrated  the 
development  of  bacteria  from  spores.  It  is  hardly  neces- 
sary to  discuss  this  theory  further,  but  I  may  mention  the 
labors  of  Panum  and  of  Brieger,  who  deeply  investigated 
the  poisons  produced  by  bacteria,  to  which  are  given  the 
general  titles  of  ptomaines  and  toxins. 

It  would  be  unjust,  however,  did  T  not  mention  the 
name  of  Lister  in  connection  with  the  inestimable  benefit 
that  has  accrued  to  surgery  Irom  the  practical  application 
of  the  theory  of  infection  to  wounds, — a  measure  that 
brought  about  an  entire  revolution  in  surgery  and  surgical 
technique,  and  an  entire  reversal  of  the  statistics  of  oper- 
ations; where  thousands  formerly  died,  thousands  now  live, 
their  lives  being  indirectly  due  to  the  labors  of  this  one 
man  and  his  following. 

I  will  add  that  it  is  necessary  to  realize  the  difference 
between  life  and  death  to  appreciate  the  changes  tliat  have 
been  brought  about  during  the  last  score  of  years.  Much 
that  in  former  years  was  unjustifiable  has  become  both 
justifiable  and  feasible ;  to-day  patients,  as  a  matter  of 
course,  live  after  operations  which,  so  recently  as  when  I 


262  THE    HISTORY    OF    MEDICINE. 

was  a  student,  were  considered  impossible,  or  if  performed 
exposed  the  operator  to  the  charge  of  manslaughter. 

I  have  spoken  of  the  impulse  wliicli  came  from  Aven- 
brugger's  invention  of  percussion,  which  was  greatly  ex- 
tended through  the  translation  of  his  work  by  Corvisart 
(1755-1821)  ;  the  latter  also  excelled  as  a  clinical  teacher 
and  pathological  anatomist,  and  had  much  to  do  with  the 
education  of  others  of  his  confreres  whose  names  are  lus- 
trous in  history.  Among  the  most  celebrated  was  Laennec 
(1781-1826),  who,  though  brought  up  among  most  trying 
surroundings,  early  manifested  a  zeal  for  medicine.  He 
became  a  field-surgeon  in  the  French  army  soon  after  the 
Reign  of  Terror,  and  pushed  his  classical  and  medical 
studies  with  restless  zeal.  In  1815  his  first  experi- 
ments were  made  with  the  stethoscope,  the  invention  of 
which  was  due  to  accident:  in  order  to  hear  the  sounds 
of  the  heart  more  clearly,  he  one  day  applied  a  cylindrical 
roll  of  paper,  and  then  immediately  constructed  the  whole 
form  of  the  stethoscope  upon  the  principle  now  every- 
where resorted  to.  In  1819  he  published  his  work  on 
Mediate  Auscultation^ — ^a  treatise  on  prognosis  in  disease  of 
the  lungs  and  heart,  based  principally  upon  this  new  aid 
to  investigation.  The  treatise  was  speedily  translated  into 
all  the  languages  of  Europe.  After  enjoying  a  large  prac- 
tice Laennec  succumbed  to  ill  health  at  the  early  age  of 
forty-five.  He  seems  to  have  had  but  slight  appreciation  of 
his  own  services  to  medicine,  and  to  have  prided  himself 
rather  on  his  skill  in  riding  horseback.  Honor  and  fame, 
however,  followed  closely  upon  the  publication  of  his  well- 
known  work,  and  the  manuals  of  physical  diagnosis  which 
now  find  frequent  mention  in  book  catalogues,  and  come 
from  various  and  wide  sources  are  the  legitimate  outcome 
of  Avenbrugger's  and  of  Laennec's  pioneer  treatises. 

A  versatile  Frencli  writer  who  devoted  especial  attention 
to  medical  nomenclature  was  Piorry  (1794-1879),  to  whom 


EXACT   METHODS   IN    DIAGNOSIS.  263 

we  are  indebted  for  the  pleximeter.  The  double  stetlio- 
scope,  a  legitimate  extension  of  Laennec's  simple  instru- 
ment, was  invented  by  Cammann,  of  New  York,  and  can 
justly  be  claimed  for  American  medicine.  Other  methods 
of  physical  examination — like  spirometry,  chest  measure- 
ment, and  study  of  expired  air — have  been  introduced 
since  1846.  The  ophthalmoscope,  which  has  been  of  such 
sterling  service,  and  is  based  upon  the  simplest  of  princi- 
ples, was  the  invention  of  the  famous  Helmholtz,  but  just 
deceased.  The  principle  of  endoscopy, — the  illumination 
and  visual  examination  of  the  various  cavities  of  the 
human  body, — the  various  specula,  the  spectroscope,  the 
sphygmograph,  the  more  accurate  record  of  physical 
sounds,  the  application  of  electricity,  and  the  employment 
of  thermometry  represent  a  few  of  the  strides  in  the 
medical  science  of  the  present  century,  thereby  aiding  and 
perfecting  the  art  of  diagnosis,  which,  in  turn,  must  ever 
necessarily  form  the  basis  for  all  rational  treatment.  Let 
no  one  complain  that  we  are  still  so  far  from  certainty  in 
every  case ;  the  wonder  is  that  so  much  has  been  discovered 
in  so  short  a  space  of  time. 

Wonderful  as  have  been  these  advances,  the  greatest 
achievements  have  accrued  to  the  department  of  sur- 
gery, which  Chamisso  terms  "  the  seeing  portion  of  the 
healing  art."  The  sixteenth  century  opened  the  way  for 
checking  of  hsemorrhages  ;  the  seventeenth  accomplished 
great  simplifications  and  improvement  in  the  way  of  dress- 
ing wounds ;  the  eighteenth  gave  a  refining  and  elevating 
tendency  to  the  study  of  applied  practice,  and  raised  sur- 
gery to  a  level  with  other  branches  of  science ;  and  now 
the  nineteenth  century  has,  toward  its  close,  made  surgery 
as  nearly,  perhaps,  as  it  ever  can  be,  an  exact  science,  to 
which  every  other  branch  of  science  has  been  made  con- 
tributory. The  chain-saw,  invented  in  1806  by  Jefiery, 
alone  gave  an  impetus  to  resection,  which  was  cultivated 
especially  in  Germany  ;  to  resection  was  added  osteotomy  by 


264  THE    HISTORY    OF    MEDICINE. 

Heine  and  Mayer ;  this,  in  turn,  was  succeeded  by  the  so- 
called  subcutaneous  osteotomy  of  Langenbeck  in  185-4  ; 
Stromeyer  introduced  subcutaneous  tenotomy  in  1831, 
which  was  a  very  pronounced  advance  on  all  that  had 
gone  before ;  then  came  the  introduction  of  anaesthesia,  by 
which  were  made  possible  operations  that  had  been  beyond 
human  endurance ;  by  the  introduction  of  the  rubber 
bandage  by  Esmarch  in  1873  bloodless  methods  were  made 
possible.  Pain  and  haemorrhage,  the  two  greatest  enemies 
of  the  conscientious  surgeon,  being  thus  almost  anniliilated, 
there  was  left  but  an  apparently  theoretical  limit  to  what 
the  surgeon  might  accomplish.  Orthopaedic  surgery,  in- 
troduced by  Delpech,  was  unknown  prior  to  1816;  it  was 
first  practiced  systematically  by  Stromeyer  and  popularized 
in  France  by  Guerin.  Operations  on  nerves  were  studied 
as  special  methods  by  Schuh,  Wernher,  and  Nussbaum. 
Jobert  and  Simon  abroad,  and  Sims  and  Emmet  in  the 
United  States,  by  their  studies  of  fistulae  peculiar  to  the 
genito-urinary  tract  in  females,  have  conferred  inestimable 
benefits  upon  suffering  womanhood.  So  late  as  1839  Vidal 
declared  there  did  not  exist  in  the  history  of  surgery  a 
single  well-authenticated  case  of  complete  cure  of  vesico- 
vaginal tear. 

It  is  not  my  intention  to  more  than  barely  refer  to 
the  living  surgeons  of  to-day,  or  those  who  have  but  very 
recently  passed  away  from  us ;  but  it  would  be  an  injustice 
to  overlook  Bernhard  von  Langenbeck  and  Theodor  Bill- 
roth. The  former,  born  in  1810  and  deceased  in  1887, 
.was  for  a  time  a  teacher  of  physiology,  but  subsequently 
became  successor  of  Dieffenbach  in  the  University  of  Berlin. 
The  influence  he  exerted  upon  surgery  in  Germany  and 
(since  the  decline  of  French  precedence)  upon  surgery  all 
over  the  world,  has  perhaps  been  greater  than  that  of  any 
one  man  since  Dupuytren's  time.  He  it  was  that  intro- 
duced into  surgical  technique  and  surgical  pathology  the 
experimental  method  of  which  Johannes  Miiller  was  the 


B.    VON    LANGENBECK. 


265 


great  exponent;  indeed,  the  relatively  high  importance 
which  pathology  is  given  to-day  in  every  surgical  curricu- 
lum is  due  more  to  his  labors  than  to  those  of  any  other 
one  man.  Genial,  learned,  indefatigable,  he  was  the  ideal 
accomplished  teacher.  It  would  be  impossible  in  any 
short  resume  of  his  life  and  labors  to  do  justice  to  so  dis- 
tinguished a  man,  to  whom  the  profession  owes  so  much. 
Perhaps  the  highest  testimonial  that  could  be  given  would 


FxG.  38.— Bernhard  von  Langenbeck. 

(From  a  photograph.) 


be  the  enumeration  of  the  men  who  were  ever  and  always 
his  enthusiastic  admirers.  Langenbeck  was  the  founder  of 
the  German  Congress  of  Surgeons,  and  for  many  years  its 
president,  and  the  permanent  home  this  association  has 
built  for  itself  in  Berlin  bears  his  name ;  the  surgical  journal 
he  founded  has  now  passed  its  fiftieth  volume,  and  is  to- 
day the  first  periodical  of  its  class  in  any  country  or 
language. 


266 


THE   HISTORY   OF    MEDICINE. 


Theodor  Billroth,  who  only  within  a  few  years  joined 
the  great  silent  majority,  was  for  many  years  the  surgical 
sun  of  Austro-Hungary,  around  whom  revolved  all  the 
other  lights  of  the  profession  in  the  empire.  He  was  as 
expert  with  the  microscope  as  with  the  knife,  and  equally 
great  with  both.  Although  his  great  and  elaborate  work 
on  Coccohacteria  Septica  is  now  obsolete,  it  nevertheless 
marked  an  era  in  surgical  pathology,  as  does  also  his  text- 


FiG.  39.— Theodor  Billroth. 
(From  an  engraving  of  ■  recent  photograph.) 


book  on  the  same  subject,  which  reached  fifteen  editions 
and  has  been  widely  translated.  He  it  was  who  made  the 
first  resection  of  the  larynx  and  of  the  stomach,  and  to  him 
we  are  indebted  for  many  other  daring  operations.  It  was 
the  fame  of  this  teacher  that  in  recent  years  led  young 
Americans  to  Vienna,  and  he  set  the  example  in  every  way 
for  a  constantly  growing  number  of  students  whose  names 
are,  or  ere  long  will  be,  famous.     Billroth  was  born,  in 


FRENCH  SURGEONS  OF  THE  XIX  CENTURY.      267 

1819,  ill  Bergen,  and  succeeded  Sclinli  in  Vienna,  after 
having-  taught  most  acceptahly  at  Ziivicli.  What  he  was 
to  his  teacher,  Langenbeck,  such  are  the  younger  German 
surgeons,  like  Czerny,  Gussenbauer,  Mikulicz,  and  others, 
to  him.     The  Russian,  Pirogoff,  also  deserves  a  place  here. 

Here  may  be  recalled  the  pride  with  which  Americans 
greet  the  name  of  McDowell,  who  performed  the  first 
ovariotomy,  and  prepared  the  way  for  a  branch  of  ab- 
dominal surgery  the  results  of  which  have  fairly  astonished 
the  world. 

There  is  much  to  be  said  also  for  certain  measures,  such 
as  the  introduction  into  surgery  of  plaster  of  Paris,  by 
Larrey ;  of  starched  bandages,  by  Seutin ;  of  absorbable 
material  for  ligatures  and  sutures,  the  latter  from  animal 
sources.  Finally,  antiseptic — or,  better,  aseptic — methods 
of  operating  and  caring  for  injuries  and  wounds  have 
worked  a  revolution  in  methods  and  results  that  is,  perhaps, 
the  most  important  known  to  medical  history. 

At  the  beginning  of  the  present  century  the  French 
appeared  to  lead  in  matters  surgical,  and  were  distinguished 
by  dexterity  in  operating,  fertility  of  invention,  accuracy  of 
observation,  and  clearness  of  clinical  teaching.  The 
foundation  of  this  reputation  was  laid  by  Desault,  and 
upon  it  his  successors  continued  to  build.  From  his  school 
descended  the  barber-surgeon  Boyer  (1757-1833),  who 
became  the  first  surgeon  and  trusted  adviser  of  Napoleon, 
and  was  by  him  created  a  baron.  He  was  the  author  of  a 
work,  in  eleven  volumes,  which  has  survived  many  editions 
and  translations,  and  therein  lie  laid  especial  stress  upon 
after-treatment.  Richerand  (1779-1840),  like  Boyer,  was 
made  a  baron,  and  was  a  professor  in  Paris ;  but  his  char- 
acter suffered  from  his  overweening  ambition  and  vanity ; 
he  was  wont  to  exhibit  most  unpleasant  personal  traits ; 
nevertheless  his  surgical  ability  entitles  him  to  front  rank 
among  his  contemporaries.  The  third  surgeon  honored 
with  the  rank  of  baron  was  Larrey  (1766-1842),  surgeon- 


268  THE    HISTORY    OF   MEDICINE. 

in-cliief  to  the  Grand  Army,  and  whom  Napoleon  I  called 
the  most  virtuous  of  men.  In  1792  he  joined  the  Army  of 
tlie  Rhine,  and  was  the  physician  of  the  so-called  "flying- 
ambulance"  for  twenty-two  years.  He  was  present  in  sixty 
great  battles  (including  that  of  Waterloo)  and  four  hundred 
engagements,  and  was  three  times  wounded.  His  memoirs 
and  monographs  on  subjects  connected  with  military  sur- 
gery cause  him  to  be  often  quoted  even  at  the  present  day. 
It  is  recorded  that  he  performed  two  hundred  amputations 
in  a  single  day ;  during  the  march  through  Russia  he  had 
at  one  time  in  Smolensk  ten  thousand  men  to  care  for  in 
one  hospital.  A  wonderful  organizer,  he  was  idolized  by 
the  soldiers,  and  seems  to  have  been  held  in  nearly  the 
same  esteem  as  his  great  prototype,  Ambroise  Pare. 

The  most  famous  French  surgeon  of  this  century, — 
equally  celebrated  as  a  diagnostician,  as  an  operator,  and 
as  a  teacher, — was  Baron  Dupuytren  (1777-1835).  As 
a  child  \r  had  been  stolen,  on  account  of  his  eminent 
beauty.  His  early  life  was  one  of  poverty  and  want. 
He  zealously  devoted  himself  to  anatomy  and  physiology 
as  foundations  for  successful  work  in  surgery,  and  ulti- 
mately secured  a  private  practice  that  embraced  all  France, 
and,  when  visiting  other  countries,  was  received  like  a 
prince.  For  years  he  devoted  three  hours  daily  to  didactic 
lectures.  He  died,  leaving  a  fortune  of  several  millions  of 
francs ;  he  even  offered  to  the  exiled  Charles  of  England 
a  million  francs  as  a  trifling  recompense  for  his  misfortime. 
He  was  known  as  "  Tlie  Napoleon  of  Surgery," —  a  title 
well  earned,  yet  one  which  drew  upon  him  the  enmity 
of  many  of  his  contemporaries,  particularly  as  he  seemed 
inclined  to  persecute  all  who  dared  to  tread  in  his  path. 
His  death  resulted  from  empyema,  for  which  he  declined 
operation,  preferring,  as  he  said,  "  to  die  at  the  hands  of 
God,  rather  than  man." 

The  first  truly  scientific  practitioner  of  orthopaedic 
surgery  in  France  was  Delpech  (1777-1832),  of  Toulouse, 


FRENCH  SURGEONS  OF  THE  XIX  CENTURY.      '2G9 

who  was  likewise  the  pioneer  in  suhcutaneous  tenotomy  of 
the  tendo  AcliilHs  and  in  autoplastic  operations.  At  his 
own  expense  he  erected  a  large  orthopaedic  institute  in 
Montpellier,  and  his  death  occurred  while  on  his  way  to 
pay  a  visit  to  this  institution,  both  he  and  his  coacliman 
being  shot  by  an  insane  patient  upon  whom  he  had 
operated. 

Dupuytren's  successor  in  the  Hotel-Dieu  was  Roux 
(1780-1854),  who  earned  specific  reputation  as  a  dextrous 
and  rapid  operator ;  his  labors  in  constructive  and  plastic 
surgery  were  extraordinary.  The  first  to  apply  physical 
investigation  to  surgery  was  Lisfranc  (1790-1847), — best 
remembered,  perhaps,  in  connection  with  amputation  of  the 
foot.  Marjolin  (1770-1850)  was  a  teacher  of  eminence,  as 
were  also  Sanson  (1790-1841)  and  Cloquet  (1790-1883), 
though  the  latter  is  better  remembered  for  his  works 
on  anatomy  tlian  for  his  exploits  in  surgery.  Civiale 
(1792-1867)  is  chiefly  famous  for  revamping  the  operation 
of  lithotrity,  for,  though  a  lithotrite  had  been  invented  by 
d'Etoilles,  Civiale  was  the  first  actual  operator,  for  which 
he  was  fiercely  opposed  by  Larrey,  Sanson,  Velpeau,  and 
others ;  he  lived  to  see  his  rivals  confounded  and  lithotrity 
accepted  as  a  legitimate  surgical  procedure.  Amussat 
(1796—1856)  reinvented  torsion  of  arteries  lor  the  repres- 
sion of  haemorrhage,  for,  although  this  measure  had  been 
suggested  by  the  ancients,  it  was  held  to  be  suitable  only 
for  very  small  vessels  ;  he  never  held  a  professorship,  yet  at 
his  residence  were  held  his  so-called  "conferences"  that 
were  attended  by  the  most  eminent  medical  men  of  the 
time;  he  is  specially  known  in  connection  with  the  oper- 
ation for  opening  the  colon  in  the  lumbar  region.  Pravaz 
was  a  surgeon  of  Lyons,  whose  name  lias  been  ])erpetuated 
by  the  small  syringt^ — tlie  original  hypodermatic — which  he 
devised.  Vidal  de  Cassis  (1803-1856)  made  a  reputation 
by  his  work  on  Surgerf/,  in  five  volumes,  which  was  exten- 
sively translated  and  reprinted  tliroughout  Europe.     Jobert 


270  THE    HISTORY   OF    MEDICINE. 

de  Lamballe  (1799-1867)  rose  from  abject  poverty  to  a 
professorship  and  a  seat  in  the  Academie;  he  is  particularly 
remembered  for  his  achievements  in  plastic  operations. 
Velpeau  (1795-1868)  in  183-1  became  the  successor  of 
Boyer ;  popular  as  a  teacher,  and  an  author  of  great  fer- 
tility, he  devoted  attention  alike  to  surgery  and  midwifery ; 
his  Operative  Surgery^  in  three  volumes,  and  a  treatise  on 
Diseases  of  the  Mammary  Gland  are  still  classics.  Gerdy 
(1797-1856),  like  Velpeau,  was  the  son  of  poverty-stricken 
parents ;  in  1833  he  became  a  professor,  and  wrote  exten- 
sively on  bandages,  dressings,  and  on  operation  for  the 
radical  cure  of  hernia.  Bonnet  (1802-1858)  rendered  great 
service  to  surgery  by  his  researches  upon  diseases  of  the 
joints.  Malgaigne  (1806-1865),  made  Professor  of  Oper- 
ative Surgery  in  Paris  in  1865,  devoted  great  attention  to 
surgical  anatomy,  operative  and  experimental  surgery,  and 
especially  to  fractures  and  dislocations, — his  work  on  fract- 
ures is  met  with  on  many  book-shelves  to-day.  Nelaton 
(1807-1874)  was  surgeon  to  Emperor  Napoleon  III,  and, 
though  he  wrote  little,  became  peculiarly  eminent  as  a 
practitioner;  his  ingenious  probe,  tipped  with  porcelain,  by 
means  of  which  he  located  a  bullet  in  the  foot  of  Garibaldi, 
is  well  known.  He  devoted  special  attention  to  tubercu- 
losis of  bones  and  joints,  being,  perhaps,  further  instigated 
thereto  by  the  case  of  the  Prince  Imperial ;  his  treatise  on 
this  subject  forms  most  acceptable  reading  to-day,  and  he 
taught  the  existence  of  osseous  tuberculosis  long  before  such 
was  recognized  in  either  Great  Britain,  Germany,  or  the 
United  States. 

Were  I  to  refer  to  living  contemporaries  of  many  of 
the  celebrities  just  mentioned,  I  should  speak  with  special 
reverence  and  esteem  of  Pean  and  Verncuil,  recentlv  dead, 
and  Oilier,  who  are  or  were  the  greatest  surgeons  in  France  ; 
but  with  their  lives  and  labors  any  one  may  easily  acquaint 
himself  from  sources  which  are  at  the  command  of  all. 

I  pass  now  to  tlie  Italians,   who,   since  Scarpa's  time 


ENGLISH    SURGEONS   OF   THE   XIX   CENTURY.  271 

have  never  made  any  very  decided  impression  upon  surgery, 
altboQgh  there  are  many  most  excellent  practitioners  of 
the  art  in  Italy;  the  best  known  are  Porta  (1800-1875), 
Vanzetta  (born  in  1809),  and  Rizzoli  (who  died  in  1880); 
Riberi,  Tizzoni,  Loreta,  Durante,  and  others  are,  perhaps, 
equally  entitled  to  mention. 

Since  the  time  of  Gimbernat  there  have  been  no  surgeons 
in  Spain  whose  services  have  been  sufficiently  important  to 
rouse  special  attention  away  from  their  native  peninsula. 
The  Spaniards  are  well  educated,  and  well  equipped  for 
practice,  but  do  not  appear  as  great  originators  nor  experi- 
menters; doubtless  because  their  medical  schools  and 
universities  long  since  lost  prestige,  owing  to  clerical  and 
Inquisitorial  interference ;  nevertheless,  Spanish  medical 
literature  has  kept  well  abreast  with  that  of  other  countries. 

In  Great  Britain  the  example  of  John  Hunter,  during 
the  eighteenth  century,  produced  results  of  the  greatest 
importance;  advances  were  made  simultaneously  in  physi- 
ology and  pathology  which  the  Anglo-Saxon  races  have 
been  quick  to  utilize.  While,  perhaps,  more  conservative 
and  less  inventive  than  the  French,  the  surgeons  of  England 
have  ever  been  in  the  front*  rank,  and  quite  early  they 
gave  great  attention  to  careful  local  dietetic  and  hygienic 
measures,  of  which  Continental  surgeons  were,  and  are,  too 
often  neglectful.  English  surgeons,  too,  while  they  have 
been  specialists,  have  never  been  quite  so  narrow  in  their 
respective  fields  as  the  Continental  surgeons,  and  it  has 
always  been  rare  to  find  one  who  was  not  also  a  good 
general  practitioner;  the  immense  advantages  which  this 
added  knowledge  confers  must  be  apparent.  The  most 
celebrated  representative  of  British  surgery  of  this  century 
was  the  son  of  a  clergyman, — Sir  Astley  Cooper,  born  in 
Norfolk  in  1748,  but  subsequently  a  resident  of  London. 
During  youth  he  resolutely  compressed  the  bleeding  limb 
of  a  playmate  who  was  the  victim  of  an  accident,  so  that 
time  was  gained  for  the  arrival  of  a  surgeon,  who  then  tied 


272  THE    HISTORY    OF    MEDICINE. 

the  vessel ;  this  decided  his  future  calling,  and  he  pursued 
his  studies  in  London,  Edinburgh,  and  on  the  Continent, 
In  1791  he  settled  down  to  private  practice,  which  soon 
yielded  him  an  income  in  excess  of  c£20,000  ($100,000), 
for  his  day  the  equivalent  of  thrice  that  amount  at  present. 
At  the  age  of  seventy-three  he  succumbed  to  a  long- 
standing asthma.  He  was  a  somewhat  voluminous  writer, 
and  his  works  on  fractures,  dislocations,  and  diseases  of  the 


Fio.  40.— Sir  Astlky  Cooper,  Bart. 

(From  a  steel  engraving  of  an  original  drawing  by  J.  W.  Bubidge.) 

breast  are  by  no  means  obsolete.  His  motto  was :  "  First 
observe,  and  then  think."  Exceptionally  endowed  with  all 
the  graces  of  person,  he  became  one  of  the  most  popular 
and  influential  men  of  his  day  ;  withal,  he  was  always 
zealous  for  his  profession,  never  unoccupied,  and  charitable 
to  a  high  degree.  Of  his  boldness  we  have  evidence  in 
the  fact  that  in  1817  he  tied  the  abdominal  aorta,  being 
the  first  to  undertake  this  surgical  feat. 


ENGLISH  SURGEONS  OF  THE  XIX  CENTURY.      273 

A  colleague  of  Cooper's  at  St.  Thomas's  Hospital  was 
Travers,  already  spoken  of  in  connection  with  irritation. 
Tyrrel,  a  nephew  of  Cooper,  was  a  well-known  surgeon, 
particularly  in  diseases  of  the  eye.  Others  of  the  same  name 
were:  Samuel  Cooper  (1781-1848),  who  wrote  a  volu- 
minous treatise  on  practical  surgery ;  Bran  shy  Cooper 
(1792-1853),  Sir  Astley's  nephew  and  adopted  son,  who 


Fio.  41.— Sib  Benjamin  Collins  Brodie,  Bart.,  F.R.S. 

(From  a  steel  engraving  by  J.  Braiu.of  a  painting  by  H.  Room.) 

was  well  known,  and  who  achieved  an  eminence  that  is 
only  dimmed  hy  that  of  his  uncle. 

Sir  Benjamin  Brodie  (1783-1862)  was  distinguished 
as  a  special  investigator  and  a  soft-tissue  operator,  of  whom 
it  is  said  that,  basing  his  actions  upon  his  statistics,  the 
older  he  became,  the  less  frequently  he  operated.  His  best- 
known  writings  concern  diseases  of  the  joints.  Guthrie 
(1785-1856),  a  man  of  noble  characteristics,  was  the  friend 

18 


274  THE    HISTORY    OF    MEDICINE. 

and  companion  of  Wellington,  whom  he  accompanied  in  all 
his  campaigns.  Although  well  known  as  a  lithotomist,  Ids 
fame  rests  chiefly  upon  studies  and  writings  in  the  domain 
of  military  surgery.  A  colleague  of  his  in  the  Westminster 
Hospital,  Sir  AVilliam  Lawrence  (1783-1867),  was  surgeon 
to  the  queen,  highly  esteemed  as  a  dextrous  operator,  and 
an  authority  on  ruptures  and  on  operative  surgery.  John 
Lizars  (1783-1861)  was  a  pupil  of  John  Bell,  and  distin- 
guished himself  as  a  bold  operator  and  fertile  writer ;  early 
in  the  century  he  treated  chronic  hydrocephalus  by  oper- 
ation. E-obert  Listen  (1794-1847)  was  another  remark- 
able surgeon  and  a  wonderful  operator.  Sir  Cliarles  Bell 
(1774-1842)  has  already  been  mentioned  for  his  researches 
on  the  nerves,  and  he  also  wrote  on  operative  surgery,  and 
is  somewhat  famed  for  his  opposition  to  venesection. 

Li  Edinburgh  James  Syme  (1799-1870)  secured  great 
reputation  both  by  his  dexterity  as  an  operator — which  is 
spoken  of  by  his  own  pupils  as  marvelous — and  by  his  in- 
troduction of  resection  into  general  practice.  Sir  James  Y. 
Simpson  (1811-1870)  aided  to  make  the  Edinburgh  school 
famous  by  his  researches  into  the  domain  of  both  surgery 
and  obstetrics.  Though  the  inventor  of  acupressure,  his 
name  will  forever  be  associated  with  the  introduction  of 
chloroform.  Professor  Dunn  says  that,  "  after  seeing  the 
terrible  agony  of  a  poor  Highland  woman  under  amputation 
of  the  breast,  Simpson  left  the  class-room  and  went  straight 
to  Parliament  House  to  seek  work  as  a  solicitor's  clerk. 
But  on  second  thought  he  returned  to  the  study  of  medi- 
cine, asking :  'Can  anything  be  done  to  make  operations 
less  painfulV  The  ultimate  result  was  the  discovery  of 
chloroform,  and  so  tlie  suffering  of  one  became  the  occasion 
of  the  deliverance  of  many."  Upon  his  advocacy  of  chloro- 
form in  obstetrics  lie  had  to  defend  himself  against  most 
vehement  attacks  of  both  Scotch  and  English  clergymen, 
who  affected  to  regard  such  procedure  as  a  crime  that 
transgressed  the  will  of  the  Deity  ;  but  he  successfully  con- 


ENGLISH  SURGEONS  OF  THE  XIX  CENTURY.      275 

founded  these  assailants  with  their  own  weapons,  proving 
himself  their  more  than  equal  in  knowledge  of  Scripture 
lore. 

Many  other  British  surgeons,  living  and  dead,  deserve 
most  honorable  mention,  but  time  and  space  will  not 
permit.  I  cannot,  however,  pass  by  without  mentioning 
Curling,  Annandale,  Chiene,  Cheyne,  Macewen,  Ogston, 
Jonathan  Hutchinson,  Sir  James  Paget,  Christopher  Heath, 
Thomas  Langmore,  Savory,  Holden,  Holmes,  Adams,  Sir 
Joseph  Lister,  and  Sir  Prescott  Hewitt,  of  the  value  of 
whose  labors  I  have  already  tried  to  speak;  Sir  William 
Ferguson,  of  whom  it  is  said  that  he  had  the  eagle's  eye,  a 
lion's  heart,  and  a  lady's  hand  ;  John  Bowman,  best  known 
for  his  work  in  ophthalmic  surgery  ;  Sir  Henry  Thompson, 
the  eminent  lithotomist  and  lithotritist ;  and  Sir  Spencer 
Wells,  Keith,  Lawson  Tait,  and  Bantock,  whose  names  are 
inseparable  from  the  history  of  abdominal  surgery.  And 
what  can  be  said  of  the  young  men  who  are  being  trained 
in  the  methods  and  practice  of  their  predecessors — trained 
not  only  in  the  direction  of  manual  dexterity,  but  in  ex- 
perimental science,  to  which  they  make  the  former  sub- 
servient 1  All  honor  to  these  scions  of  Great  Britain's 
surgical  art,  who  have  astonished  the  world  with  their  con- 
summate ability !  I  would  that  time  permitted  recapitu- 
lation of  the  work  accomplished  in  late  years  by  the  present 
generation  of  men  in  London,  Edinburgh,  and  other  med- 
ical centres ;  but  the  scope  of  these  chapters  does  not  cover 
this  ground. 


CHAPTER  XL 

HISTORY    OF    MEDICINE    IN    AMERICA. 

The  Colonial  Physicians.  Medical  Study  under  Preceptors.  Inoculation  against 
Smallpox.  Military  Surgery  during  the  Kevolutiouarj'  War.  Earliest 
Medical  Teaching  and  Teachers  in  this  Countrj'.  The  First  Medical  Schools. 
Benjamin  Rush,  1745-1813.  The  First  Medical  Journals.  Brief  List  of 
the  Best-Known  American  Physicians  and  Surgeons. 

The  Ijistory  of  medicine  in  America  commences  with 
the  early  struggles  of  the  physicians  in  the  American  colo- 
nies. One  Dr.  Wootton  came  to  Virginia  hi  1607  as  Sur- 
geon-General of  the  London  Company.  The  following 
year  Ur.  Russell  was  with  Captain  Smith  in  his  explora- 
tion of  Chesapeake  Bay.  Neitlier  of  these  men  stayed 
long  in  the  country,  since,  m  1609,  Captain  Smith,  after 
being  wounded,  was  compelled  to  return  to  England  for 
treatment,  for  lack  of  medical  aid. 

When,  in  1626,  Peter  Minuit  purchased  the  island  of 
Manhattan  for  the  sum  of  twenty-four  dollars^  there  was 
probably  no  physician  there  at  the  time.  Undoubtedly  the 
first  physician,  in  what  is  now  New  York,  was  Lamontagiie, 
— a  Huguenot,  who  arrived  in  1637,  and  who  seems  to 
have  been  a  man  of  great  capability  for  his  time.  It  would 
appear  that  men  of  no  little  eminence  left  the  Old  World 
for  the  New  during  tlie  early  days  of  the  American  colonies, 
and  that  the  medical  services  which  the  early  colonists 
received  were  on  a  par  with  those  received  by  those  whom 
they  left  behind  in  their  old  homes.  During  the  seven- 
teenth century  a  number  of  reputable  physicians  emigrated 
to  this  country,  among  them  Dr.  John  Clark,  of  Boston,  in 
1638,  whose  son  and  grandson  followed  him  in  his  profes- 
sion and  became  prominent  in  their  chosen  calling.  In 
1644  came  Dr.  Child,  a  graduate  of  Padua,  who  seems  to 
have  been  a  man  of  great  learning. 

A  number  of  younger  Americans  also  went  abroad 
(276) 


PHYSICIANS   OFTEN    WERE   CLERGYMEN.  277 

to  study, — Leyden,  Paris,  Padua,  and  the  British  univer- 
sities being-  those  most  eagerly  sought.  In  Virginia,  so 
early  as  1619,  the  Colonial  Assembly  discussed  the  erection 
of  a  university  or  college.  In  1637  a  public  college  was 
established  in  Cambridge,  and  in  1638  the  liev.  John  Har- 
vard left  to  it  his  library  and  half  his  fortune,  after  which 
it  was  called  Harvard  College.  William  and  Mary  College 
was  chartered  in  Virginia  in  1693.  Probably  the  first  lect- 
ures in  anatomy  given  in  this  country  were  those  of  Giles 
Firman,  which  were  given  previous  to  1647  at  Harvard 
College. 

It  was  in  this  early  day  that  arose  the  custom,  con- 
tinued until  very  recently,  of  studying  medicine  with  a 
preceptor.  This  was  necessary  at  that  time,  and  until 
comparatively  recently,  because  of  the  scarcity  of  institu- 
tions of  learning  and  the  expense  connected  with  an  educa- 
tion. The  form  of  apprenticeship  was  often  gone  through 
with  for  a  term  of  years  varying  from  three  to  seven, 
during  which  time  the  young  student  performed  the  most 
menial  duties,  had  very  meagre  opportunity  for  anatomical 
study,  and  acquired  his  knowledge  rather  by  contact  with 
and  absorption  from  his  preceptor  than  in  any  other  way. 
In  this  method  of  teaching  the  personal  element  was  so 
pronounced  that  everything,  in  fact,  depended  upon  the 
preceptor,  save  what  natural  talent  and  industry  might  ac- 
complish. With  such  meagre  opportunities  the  means  for 
doing  were  equally  scant.  Nevertheless,  emergency  made- 
many  of  these  early  American  practitioners  self-reliant  and 
competent  to  treat,  according  to  the  knowledge  of  that  day, 
the  various  accidents  then  so  common.  In  1636  the  As- 
sembly of  Virginia  passed  a  fee-bill  for  surgeons  and 
apothecaries,  fees,  however,  being  often  paid  in  tobacco, 
powder,  lead,  wampum,  etc.  Not  a  few  combined  ministry 
of  the  body  and  the  soul,  and  a  number  of  eminent  physi- 
cians were  also  preachers  of  more  or  less  renown, — among 
them  John  Rogers,  John  Fisk,  and  others. 


278  THE    HISTORY    OF    MEDICINE. 

Probably  the  only  medical  work  published  in  America 
during  the  seventeenth  century  was  A  Brief  Rule  to  Guide 
the  Common  People  of  New  England  how  to  Treat  Them- 
selves and  Others  in  the  Small-pocks  or  Measels.  This  was 
printed  and  sold  in  1677,  by  John  Foster,  of  Boston.  It 
was  printed  upon  one  side  of  a  single  sheet  in  double 
columns,  and  described  both  of  these  diseases  as  due  to 
the  blood  endeavoring  to  recover  a  new  form  and  state. 

The  old  English  distinction  between  physician  and  sur- 
geon was  for  many  years  quite  generally  preserved,  but 
could  not  persist,  because  of  the  different  conditions  under 
which  men  practiced.  During  this  century,  also,  a  number 
of  midwives  made  excellent  practitioners, — among  them 
the  wife  of  Dr.  Fuller,  one  of  the  May  Flower  pilgrims. 
Those  colonial  days,  however,  seem  to  have  been  free 
from  the  ravages  of  itinerant  specialists  and  charlatans, 
who  so  abundantly  infested  Europe  at  the  time.  It  is  also 
to  the  everlasting  credit  of  the  American  profession  that 
it  took  no  part  in  the  horrible  delusions  and  scandalous 
transactions  connected  with  the  Salem  witchcraft. 

By  the  beginning  of  the  eighteenth  century  the  popu- 
lation of  the  United  States  was  about  three  hundred 
thousand  whites  ;  by  the  end  of  the  century  it  had  increased 
to  a  total  of  about  four  millions.  During  this  century  a 
larger  proportion  of  educated  medical  men  came  from 
abroad  and  settled  in  various  parts  of  the  country,  while 
the  Colonial  and  the  Revolutionary  Wars  offered  ample 
opportunity  for  the  development  and  study  of  military 
medicine  and  surgery.  Commerce  between  the  two  conti- 
nents increased  ;  communication  became  more  free,  and  the 
people  of  the  Old  World  and  the  New  were  constantly 
brought  into  closer  relation.  The  most  lively  medical  con- 
troversy of  the  century  was,  probably,  that  excited  over  the 
introduction  of  vaccination  against  small-pox.  In  previous 
sketches  I  have  had  to  intimate  that  the  greatest  enemy  of 
the  medical  profession  in  time  past  has  been  the  clergy.    In 


INOCULATION    AGAINST    SMALL-POX.         "  279 

this  particular  instance,  however,  it  was  to  the  Rev.  Cotton 
Mather,  of  Boston,  that  the  profession  is  largely  indebted 
for  tlie  Ikvor  with  which  the  new  method  was  received  in 
this  country.  In  1721  he  called  the  attention  of  various 
American  physicians  to  the  method,  then  in  vogue  in 
Turkey,  of  inoculation  with  virus  from  the  active  disease. 
Dr.  Boylston,  of  Brookline,  Mass.,  who  settled  in  Boston, 
corresponded  with  members  of  the  British  lloyal  Society 
and  finally  determined  to  put  the  method  to  actual  proof. 
In  1721  he  inoculated  his  own  son  with  the  virus  of  natural 
small-pox,  and  within  the  next  year  had  inoculated  two 
hundred  and  forty-seven  persons,  of  whom  about  two  per 
cent,  died  of  the  disease ;  while,  of  nearly  six  thousand 
persons  attacked  by  the  disease  in  the  natural  way,  more 
than  fourteen  per  cent.  died.  In  spite  of  this,  the  man  and 
the  method  were  violently  attacked  by  the  people  and  the 
profession,  and  found  their  warmest  defenders  among  the 
ranks  of  the  clergy.  Benjamin  Franklin,  then  only  sixteen 
years  of  age,  joined  with  the  rabble  in  opposing  the  inocu- 
lation method.  Boylston  was  threatened  with  hanging,  and 
had  even  to  hide  himself  for  a  time.     He  died  in  1766. 

After  the  great  discovery  of  Edward  Jenner  societies 
were  formed  for  the  promotion  of  vaccination  all  over  the 
world.  The  earliest  vaccination  in  the  United  States  was 
performed  by  Dr.  Waterhouse  (born  1754,  died  1846),  who 
operated  upon  four  of  his  own  children  in  1800. 

It  was  during  the  eighteenth  century  that  a  number 
of  our  best-known  educational  institutions  were  founded 
in  the  different  colonies, — among  them,  Yale  College, 
in  1701;  Princeton  (College  of  New  Jersey),  in  1746; 
University  of  Pennsylvania,  in  1749;  Columbia  (King's 
College),  in  1754;  and  others  only  a  little  less  known. 
In  most  of  these  latter  were  established  medical  depart- 
ments, but  the  method  of  apprenticing  students  to  phy- 
sicians was  still  in  general  observance,  no  preliminary 
education  whatever,  as  a  rule,  being  demanded.     In  1766, 


280  *  THE    HISTORY    OF   MEDICINE. 

however,  the  New  Jersey  Medical  Society  ordained  that  no 
student  be  taken  as  an  apprentice  by  any  member  of  the 
society  unless  he  had  competent  knowledge  of  Latin  and 
some  initiation  in  the  Greek.  About  the  middle  of  the 
century  Drs.  Bard  and  Middleton,  in  New  York,  and  Dr. 
Cadwallader,  in  Philadelphia,  began  giving  lectures  in 
anatomy,  while  at  Newport,  Rhode  Island,  Dr.  William 
Hunter,  between  1754  and  1756, — a  near  relative  of  the 


Fig.  42.— B.  Watekhouse,  M.D. 

famous  Hunters  of  London,  and  a  pupil  of  the  elder 
Monro, — gave  a  course  of  lectures  on  human  and  com- 
parative anatomy.  Dr.  William  Shippen,  Jr.  (1736-1808), 
— a  student  of  John  Hunter's, — returned  in  1762  to 
America,  and  gave  his  first  course  of  lectures  on  anatomy 
and  midwifery  during  the  years  immediately  following. 
His  lectures  led  to  the  formation  of  a  Medical  Department 
of  the  College  of  Philadelphia,  in  1765,  in  which  lectures 
were  continued  regularly  until  the  winter  of  1775,  when 


OUR   FIRST    MEDICAL    SCHOOL. 


281 


the  War  of  the  Revolution  interfered.  In  July  of  1776 
Shippen  was  made  Chief-Physician  of  the  Continental 
Array,  and  in  the  following  year  was  elected  by  the 
Provincial  Congress  Director-in-General  of  army  hospitals. 
During  the  latter  years  of  the  war  he  returned  to  Phila- 
delphia each  winter,  and  delivered  a  course  of  lectures. 


■ 

'^s^^iL"     \            '      Ifev 

ii<> 

m 

Fig,  43.— Surgeon's  Hall,  next  to  Philadelphia  Dispensaby,  Fifth 
•         Street  below  Library  Street. 
Foundation  of  the  Medical  Department  of  the  University  of  Pennsylvania. 
First  medical  school  in  America,  1765-1807. 

shortened  by  the  necessities  of  the  case.  Thus  he  was 
the  first  public  teacher  of  midwifery  in  this  country.  He 
was  ably  seconded  in  his  work  by  Dr.  John  Morgan 
(1735-1789),— also  a  pupil  of  Hunter  and  Monro,  who 
received  a  prominent  army  appointment  in  1775,  but 
who,    two    years   later,  was   unfortunately   dismissed   on 


282  THE    HISTORY    OF    MEDICINE. 

charges  subsequently  proved  false.  Shippen  and  Morgan 
were  for  some  time  the  only  professors  in  the  Medical 
Department  of  the  College  of  Pliiladelphia,  In  1768 
Kuhn — a  pupil  of  Linnseus — was  made  Professor  of 
Materia  Medica  and  Botany;  and  Benjamin  Rush,  a  year 
later,  was  given  the  Chair  of  Chemistry.  The  commence- 
ment of  this  institution  occurred  in  1768,  when  the  degree 
of  M.B.  was  given  to  seventeen  graduates.  In  1779 
political  reasons  led  to  the  abolition  of  the  College  of 
Philadelphia,  the  University  of  Pennsylvania  taking  its 
place.  Ten  years  later  the  former  institution  was  restored, 
and  in  1791  the  two  institutions  were  united.  The 
present  Medical  Department  of  the  University  of  Penn- 
sylvania is,  therefore,  the  legitimate  continuation  of  the 
first  medical  school  in  America. 

The  Medical  Department  of  King's  College,  New  York, 
now  Columbia  College,  was  organized  in  1767,  by  Clossey, 
an  Irishman ;  Middleton,  a  Scotchman ;  James  Smith,  a 
graduate  of  Leyden ;  Tenant,  an  alumnus  of  Princeton 
College ;  and  Bard,  who  was  by  far  the  most  eminent  of 
the  group,  a  Philadelphian  by  birth,  who  had  studied  under 
the  best  masters  in  England. 

The  Medical  Department  of  Harvard  University  was 
organized  in  1783.  Most  prominent  in  connection  with  it 
was  Dr.  John  Warren,  the  first  teacher  of  anatomy  and 
surgery,  and  the  founder  of  a  family  of  eminent  medical 
men,  whose  descendant,  Dr.  J.  Collins  Warren,  is  to-day  an 
occupant  of  the  chair  of  surgery  in  the  same  school.  The 
Medical  Department  of  Dartmouth  College  was  organized 
in  1798  by  Dr.  Nathan  Smith, — a  maji  of  great  energy 
and  unusual  versatility. 

While  these  medical  colleges  were  developing  their 
strength  the  medical  profession  were  not  idle,  and  insti- 
tutions and  libraries  sprang  up  in  various  places.  The 
Pennsylvania  Hospital,  for  instance,  founded  in  1762,  is  to 
be  credited  with  the  oldest  medical  librarv  in  this  countrv, 


STATE    SOCIETIES.       BENJAMIN    RUSH.  2«3 

many  of  its  volumes  liaving  been  selected  especially  for  it 
by  Louis,  of  Paris,  and  tbe  famous  Lettsom,  of  London. 
It  now  contains  nearly  fifteen  thousand  volumes.  The 
library  of  the  New  York  Hospital,  not  quite  so  large,  was 
founded  in  1776;  that  of  the  College  of  Physicians,  in 
Philadelphia,  in  1788.  The  profession  of  New  Jersey 
organized  the  State  Medical  Society  in  1765.  In  1781 
was  founded  the  Massachusetts  Medical  Society.  In  1787 
arose  the  College  of  Physicians  of  Philadelphia. 

In  1789  the  profession  of  Maryland  organized  the  so- 
called  Medical  and  Chirurgical  Faculty  of  Maryland,  con- 
stituting thereby  the  same  organization  as  the  societies  of 
other  States.  Before  the  close  of  the  century,  Delaware, 
New  Hampshire,  and  Soutli  Carolina  had  also  organized 
societies.  In  the  larger  cities  extensive  hospitals  were 
also  founded, — the  Pennsylvania  Hospital,  in  Philadelphia, 
in  1751,  inside  of  which  the  first  clinical  instruction  in  this 
country  was  given  by  Dr.  Thomas  Bond.  The  New  York 
Hospital  began  in  1769,  simultaneously  with  the  organi- 
zation of  the  Medical  Department  of  King's  College.  The 
first  insane-asylum  in  America  was  built  at  Williamsburgh, 
Va.,  in  1773,  although  the  charter  of  the  Pennsylvania 
Hospital,  dated  1751,  provided  for  the  care  of  lunatics, 
though  not  at  that  time  in  a  separate  institution. 

The  most  conspicuous  medical  character  of  the  century 
in  American  history  was  undotibtedly  Benjamin  Rush 
(1745-1813).  He  was  one  of  Shippen's  earliest  students 
in  anatomy,  studied  widely  abroad,  was  a  member  of  the 
Continental  Congress,  and  one  of  the  signers  of  the  Decla- 
ration of  Independence.  After  him  is  named  Hush  Medical 
College  of  Cliicago.  He  was  an  extensive  writer  on  a 
variety  of  subjects,  not  only  professional,  but  political,  phil- 
osophical, etc.  He  recognized  but  two  kinds  of  remedies, 
— stimulants  and  dc])ressants, — and  held  it  to  be  the  prin- 
cipal duty  of  the  physician  to  decide  as  to  which  were  most 
advisable  in  a  given  case.     He  called  calomel  tlie  "  Sam- 


284  THE   HISTORY   OF   MEDICINE. 

son"  of  the  materia  medica,  and  his  opponents  contended 
that  he  was  right,  since  it  had  undoubtedly  slain  its  thou- 
sands. As  an  accurate  observer  of  disease,  he  was  correct 
and  exact,  and  his  descriptions  are  to-day  both  classic  and 
reliable. 

The  study  of  practical  anatomy  has  always  been  carried 
on  in  this  country  under  great  disadvantages.  At  first  only 
the  bodies  of  executed  criminals  were  sparingly  furnished. 


Fig.  44.— Benjamin  Rush.  M.D. 

(From  a  steel  engraving  by  R.  W.  Dodson  of  a  painting  by  T.  Sully.) 

In  1 788,  in  New  York,  occurred  the  celebrated  "  doctor's 
mob,"  which  attested  the  vehemence  of  public  objection  to 
dissection,  and  which  for  two  days  defied  the  control  of 
all  the  authorities.  Secret  dissections  had  been  practiced 
in  Harvard  College  so  early  as  1771,  but  the  practice 
was  against  the  law  even  for  sixty  years  later  in  Massa- 
chusetts. Physiology,  as  such,  was  not  taught  in  any 
medical  school  in  tliis  country  during  the  century,  and  ex- 


THE    FIRST    MEDICAL   JOURNALS.  285 

perimeiital  physiology  was  practically  unknown.  Surgery 
was  eagerly  studied,  especially  during  war  times,  and  Dr. 
John  Jones  (1729-1791),  of  the  King's  College  School, 
was,  perhaps,  the  most  eminent  of  the  surgeons  of  his  day. 
Others  who  vied  with  him  were  William  Shippen,  Jr.,  the 
first  teacher  of  surgery  in  the  College  of  Philadelphia; 
John  Warren,  of  Boston;  Richard  Bayley,  of  Connecticut; 
Baynham,  of  Virginia ;  and  McKnight,  of  New  York. 

The  position  of  midwifery  during  the  earlier  years  of 
the  country  may  be,  perhaps,  understood  by  the  following 
extract  from  the  New  YorJc  Weekly  Post-Boy,  of  July, 
1745:— 

"  Last  night  died,  in  the  prime  of  life,  to  the  almost 
universal  regret  and  sorrow  of  this  city,  Mr.  John  du  Puy, 
M.D.,  man-midwife,"  etc. 

The  first  practitioner  of  obstetrics  in  New  England  was 
Dr.  Lloyd  (1723-1810),  a  pupil  of  Hunter  and  Smelley ; 
while  Dr.  Shippen,  in  Philadelphia,  endeavored  to  organize 
a  school  for  the  instruction  of  midwives,  in  which,  however, 
he  met  with  insupeiiable  difficulties. 

The  first  attempt  to  regulate  practice  in  colonial  times 
was  an  act  passed  by  the  General  Assembly  of  1760,  pro- 
viding for  at  least  a  form  of  examination  in  physic  and 
surgery,  registration,  etc.  The  first  medical  journal  to 
appear  in  the  United  States  appeared  about  1790.  It  was 
entitled  A  Journal  of  the  Practice  of  Medicine  and  Sur- 
gery and  Pharmacy  in  the  Military  Hospitals  of  France, 
consisting  merely  of  translations  from  the  French  journals 
of  military  medicine.  The  first  real  American  medical 
journal  was  the  Medical  Repository,  begun  in  1797  and 
discontinued  in  1824. 

The  present  century,  now  drawing  to  its  close,  saw  in 
its  earlier  half  the  rise  of  a  large  number  of  American  phy- 
sicians and  surgeons  who  have  made  their  names  illustrious 
for  all  time  by  their  teachings,  their  writings,  and  their 
invention  and  originality.    While  it  is,  of  course,  invidious 


286 


THE   HISTORY    OF    MEDICINE. 


to  select  names,  the  following  certainly  deserve  honorable 
mention  in  this  list,  without  the  slightest  disrespect  or 
intentional  slight  to  many  others  whose  names  must  be 
omitted  for  want  of  space. 

John  R.  Cox  (1773-1864),  an  early  student  of  Benja- 
min Rush,  filled  the  chair  of  Materia  Medica  and  Phar- 
macy in  the  University  of  Pennsylvania,  and  published  the 
American  Dispensatory  in   1806.     Caspar  Wistar  (1761- 


FiG.  45.— George  B.  Wood,  M.D. 

(From  an  engraving  by  T.  B.  Welch,  of  Philadelphia,  made  from  a  daguerreotype  hy  McClees  and 
Germon,  of  Philadelphia.) 

1818)  was  the  author  of  a  System  of  Anatomy, — held  in 
great  favor  in  his  day  as  a  text-book.  Nathaniel  Chapman 
(1780-1853)  was  Professor  of  Theory  and  Practice  in  the 
University  of  Pennsylvania  until  1850.  John  Eberle  held 
the  similar  chair  of  the  Jefferson  School  from  1825-1831. 
The  former  wrote  on  Materia  Medica  and  Therapeutics, 
the  latter  on  the  Practice  of  Medicine,  both  works  being 
exceedingly    popular.       John    W.    Francis    (1789-1861) 


NOTABLE    AMERICAN    PRACTITIONERS.  287 

taught  obstetrics  in  the  College  of  Physicians  and  Surgeons 
from  1826-1830.  Franklin  Bache  (1792-1864)  was  one 
of  the  authors  of  the  Dispensatory  of  the  United  States  of 
America,  published  in  conjunction  with  George  B.  Wood, 
who  was  Professor  of  Materia  Medica  in  the  University  of 
Pennsylvania,  and  who  wrote  also  extensively  on  his  chosen 
subject  in  monographs  and  large  works.  Robley  Dunglison 
(1789-1869)  taught  for  a  number  of  years  in  the  University 


Pig.  46.— Robley  Dunglison,  M.D. 

(From  an  engraving  by  A.  H.  Ritchie  of  a  daguerreotype  by  M.  P.  Simona.) 

of  Virginia,  but  removed  later  to  the  Jefferson  School  in 
Philadelphia.  He  was  a  man  of  great  industry  and  ver- 
satility, and  wrote  on  a  variety  of  subjects,  his  best-known 
Avork  being  his  Medical  Dictionary.  W.  E.  Horner  (1793 
-1853)  taught  anatomy  and  histology  in  the  University 
of  Pennsylvania,  and  will  long  be  remembered  for  his  re- 
searches in  these  branches.  John  AV.  Draper  (1811-1882) 
made  himself  eminent  as  well  by  his  researches  in  photog- 


288  THE   HISTORY   OF   MEDICINE. 

raphy  and  in  general  science,  as  by  the  publication  of  his 
treatise  on  Human  Physiology,  which  first  appeared  in  1853. 
Better  known  as  physiologist  was  John  C.  Dalton  (1825- 
1889),  whose  text-book  is  to-day  studied  in  many  colleges 
and  who  first  introduced  the  method  of  vivisectional  class- 
room demonstrations  in  our  own  school  here  in  Buffalo. 


Fig.  47.— Austin  Flint,  M.D. 

(From  a  steel  engraving  by  H.  B.  Uall.) 

Alonzo  Clark  (1807-1887)  was  one  of  the  most  eminent 
teachers  of  medicine  that  this  country  has  produced.  Austin 
Flint  (1812-1886)  was  also  a  famous  teacher  of  medicine 
in  New  York,  who  made  his  first  reputation  in  the  then 
small  school  in  Buff'alo.  His  text-book  on  Practice  is  the 
most  popular  American  work  on  the  subject  that  has  ever 
appeared,  and  is  still  in  general  use.     William  P.  Dewees 


NOTABLE    AMERICAN    PRACTITIONERS.  289 

(1768-1841)  was  the  author  of  a  treatise  upon  Diseases 
of  C7iildre7i,  which  reached  a  tenth  edition  and  which 
rivaled  the  similar  treatise  of  John  Forsyth  Meigs.  The 
best-known  teacher  of  dermatology  and  venereal  diseases 
was  Freeman  J.  Bumstead  (1826-1879),  author  of  the 
most  popular  work  upon  the  latter  subject  that  has  been 
issued  from  the  medical  press.  He  was  professor  of  these 
diseases  at  the  College  of  Physicians  in  New  York.     His 


Fig.  48.— John  Ray,  M.D. 

(From  a  steel  engraving  by  H.  Meyer  of  an  original  painting  in  the  British  Museum.; 

text-book  vied  with  that  produced  by  William  H.  Van 
Buren  (1819-1883),  who,  in  connection  with  Dr.  Keyes 
(still  living),  wrote  a  treatise  upon  the  Surgical  Diseases 
of  the  Oenito-  Uriyiary  Organs,  including  syphilis,  which 
has  been,  since  its  appearance,  exceedingly  popular  with 
the  medical  profession. 

Among  the  best-known  neurologists  and  alienists  of 
the  century  since  Benjamin  Rush  wrote  his  Inquiries  and 

19 


290  THE   HISTORY   OF    MEDICINE. 

Ohservations  upon  Diseases  of  the  Mind  (1812)  was  Dr. 
Isaac  Ray,  who,  in  1838,  published  a  work  upon  the 
medical  jurisprudence  of  insanity.  Dr.  Brigham  (1798- 
1849)  was  superintendent  of  the  Utica  Insane-asylum  for 
some  years  before  his  death ;  and  Dr.  Kirkbride,  who  died 
in  1883,  had  been  superintendent  of  the  Philadelphia 
Asylum  for  over  forty  years.  Dr.  John  P.  Gray  followed 
Brigham  as  superintendent  of  the  Utica  Asylum,  where  he 
remained  for  thirty-two  years,  and  founded  the  Journal  of 
Insanity. 

The  first  independent  writer  upon  diseases  of  the  eye 
was  Dr.  Frick  (1793-1870),  of  Maryland.  As  illustrating 
how  little  our  present  specialties  were  then  separated,  it  is 
worth  while  to  remark  that  Dr.  Edward  Delafield  (1794- 
1875),  who,  in  1826,  was  Professor  of  Obstetrics  and  Dis- 
eases of  Women  and  Children  in  the  College  of  Physicians 
and  Surgeons,  New  York,  delivered  at  the  same  time  a 
special  course  of  lectures  upon  diseases  of  the  eye.  The 
first  man  in  the  United  States  to  make  these  diseases  his 
exclusive  specialty  was  Dr.  Williams  (1822-1888),  of 
Cincinnati. 

It  would  be  very  wrong,  in  this  connection,  to  omit  the 
mention  of  the  name  of  Oliver  Wendell  Holmes,  the  genial 
"  Autocrat  of  the  Breakfast  Table,"  but  recently  dead  at  a 
ripe  old  age,  who  used  to  say  that  he  was  "  seventy  years 
young,"  who  was  for  a  long  time  Professor  of  Anatomy  at 
Harvard  Medical  College,  but  who  was  much  more  widely 
known  and  endeared  to  the  English-speaking  public  by  his 
beautiful  poems  and  most  attractive  prose  writings, — who, 
as  author  of  the  Chambered  Nantihis,  for  instance,  will  be 
remembered  so  long  as  the  English  language  has  a  litera- 
ture and  is  read.  He  rendered  a  great  service  to  the  med- 
ical profession  by  first  calling  attention  to  the  contagious- 
ness of  puerperal  fever.  Of  his  prose  writings,  his  medical 
essays — entitled  Currents  and  Counter-currents — make 
perhaps  tlie  most  delightful  reading. 


NOTABLE    AMERICAN    SURGEONS.  291 

Not  a  few  Americans  deserve  special  mention  as  sur- 
geons and  surgical  teachers  of  eminence  during  the  past 
hundred  years.  Without  being  invidious,  there  must, 
nevertheless,  be  mentioned  John  Collins  Warren  (1778- 
1856),  first  Professor  of  Anatomy  and  Surgery  in  the  Har- 
vard School,  under  whose  auspices  ether  was  first  admin- 
istered for  the  purpose  of  surgical  anaesthesia,  and  who  was 
the  founder,  in  1828,  of  the  Boston  Medical  and  Surgical 


Fig.  49.— Philip  Syng  Physick,  M.D. 

(From  a  steel  engraving  by  R.  W.  Dodson  of  a  painting  by  H.  Inman.) 

Journal.  He  wrote  an  extensive  treatise  upon  tumors, 
and,  it  is  stated,  first  successfully  tapped  the  pericardium. 
Philip  S.  Physick  (1768-1837),  a  pupil  of  Hunter,  has  been 
spoken  of  as  the  "  father  of  American  surgery,"  which  he 
taught  in  the  University  of  Pennsylvania.  He  was  a 
tremendous  worker,  but  wrote  very  little.  He  employed 
animal  ligatures  made  of  buckskin.  John  Syng  Dorsey 
(1783-1818)  was  a  nephew  of  Physick;  taught  anatomy 


292 


THE    HISTORY    OF    MEDICINE. 


in  the  University  of  Pennsylvania  ;  wrote  a  treatise  on  sur- 
gery, which  was  the  second  surgical  text-hook  pubhshed  in 
this  country,  and  was  the  first  in  the  United  States  to  tie 
the  external  iliac  artery.  He  died  at  the  age  of  tliirty-five, 
at  a  time  when  he  was  giving  promise  of  exceeding  emi- 
nence. Nathan  Smith  taught  in  Dartmouth,  Yale,  and 
Bowdoin  Colleges,  and  was  considered  the  best  man  of  his 
day  in  New  England. 

Ephraim  McDowell  (1772-1830)  lived  in  Danville,  Ky. 


i'liT.  oo.— Efhraim  McDowell,  M.D. 


To  him  is  justly  due  the  great  honor  of  having  performed 
the  first  rational  and  deliberate  ovarlotomt/,  which  he  did 
in  1809,  his  patient  living  for  thirty-two  years.  The  oper- 
ation was  performed  without  an  anaesthetic,  and  considering 
the  circumstances  under  which  it  was  carried  out  has  shed 
a  lustre  upon  his  name  and  brain  which  nothing  can  ever 
dim.  By  this  performance  he  became  practically  the 
father  of  modern  abdominal  surgery,  and  to  him  Americans 


NOTABLE    AMERICAN    SURGEONS.  293 

and  Euiopeans  alike  are  delighted  to  render  all  the  honor 
that  is  his  due. 

Perhaps  the  most  eminent  surgeon  of  the  country  was 
Valentine  Mott  (1785-1865),  a  pupil  of  Cooper  and  Bell, 
who  taught  in  the  College  of  Physicians  and  Surgeons, 
New  York,  until  1840,  and  in  the  University  Medical 
School  until  1860.  He  was  a  man  of  exceeding  boldness 
and  brilliancy,  whose  operations  were  performed  at  a  time 
when  anaesthesia  was  unknown,  or  was  in  its  infancy,  and 
who  probably  did  more  work  in  the  surgery  of  the  vascular 
system  tlian  any  other  surgeon  who  has  ever  lived.  He 
was  the  first  to  tie  the  arteria  innominata, — in  1818.  As 
Gross  wrote  of  him,  he  had  a  record  of  one  hundred  and 
tliirty-eight  ligations  of  various  large  arteries, — a  record 
probably  never  equaled.  He  was  also  the  first  to  do  a  suc- 
cessful extirpation  of  the  clavicle  for  tumor, — an  operation 
which  at  that  time  was  considered  very  formidable.  Though 
not  a  great  writer  himself,  he  is  best  known  among  students 
as  the  translator  and  editor  of  Velpeau's  large  work  upon 
operative  surgery. 

Dr.  George  McClellan  (1796-1847)  was  the  founder 
of  the  Jefferson  Medical  School,  and  its  first  Professor  of 
Surgery.  He  was  followed  later  by  Dr.  Thomas  D.< Mutter, 
who  left  his  surgical  museum  to  the  College  of  Physicians 
of  Philadelphia  and  endowed  a  lectureship  there,  J.  K. 
Rodger,  of  New  York ;  John  Rhea  Barton,  of  Phila- 
delphia; William  Gibson,  of  Philadelphia;  Gurdon  Buck, 
of  New  York ;  Willard  Parker,  of  New  York ;  Frank  H. 
Hamilton,  of  New  York,  who  made  his  reputation  while 
teaching  in  our  Buffalo  school,  author  of  a  most  popidar 
and  valuable  treatise  upon  fractures  and  dislocations ;  and 
Henry  B.  Sands,  of  New  York,  were  men  of  greatest 
prominence  during  the  middle  and  latter  portion  of  the 
present  century,  each  of  whom  has  contributed  in  his  way 
either  to  the  science  or  to  the  literature  of  surgery.  The 
most  prominent  figure  in  American  surgery  of  the  past 


294 


THE    HISTORY    OF    MEDICINE. 


forty  years  was  Samuel  D.  Gross,  of  Pliiladelpliia,  pro- 
fessor in  the  Jefferson  School,  to  which  he  moved  from 
Kentucky,  where  he  laid  the  foundation  for  his  attainments 
and  reputation.  He  was  an  early  writer  upon  surgical 
pathology  and  anatomy,  but  is  best  known  for  his  elaborate 


Fig.  51.— S.  D.  Gross,  M.D.,  LL.D. 
(From  a  photograph.) 


System  of  Surgery^  in  two  large  volumes,  which  has  sur- 
vived several  editions  and  is  still  most  highly  esteemed. 
Among  others  who  ought  to  be  mentioned  are  Nathan  R. 
Smith,  of  Baltimore,  the  inventor  of  the  anterior  splint; 
Paul  F.  Eve,  of  Nasliville  ;  John  T.  Hodgen,  of  St.  Louis; 


NOTABLE    AMERICAN    SURGEONS.  295 

Daniel  Brainard,  of  Chicago,  and  his  successor,  Moses 
Giinn ;  Alden  March,  of  Albany ;  Henry  J.  Bigelow,  of 
Boston,  who  performed  the  first  excision  of  the  hip  in 
this  country,  in  1852,  and  who  invented  the  method 
of  crushing  and  removing  stone  from  the  bladder  at  a 
single  operation,  known  as  litholapaxy ;  and  D.  Hayes 
Agnew,  of  Pliiladelpliia,  who  finished,  before  his  death, 
a  large  and  elaborate  treatise  on  surgery,  in  three  thick 
volumes. 

Of  obstetricians  and  gynaecologists  America  has  had  no 
lack,  and,  in  fact,  the  United  States  may  almost  be  said  to 
be  the  first  home  of  gynaecology.  Dr.  Bard  was  the  first 
Professor  of  Midwifery  in  King's  College,  now  Columbia, 
New  York,  and  the  author  of  the  first  work  upon  the 
subject  published  in  this  country.  In  Philadelphia,  Dr. 
Thomas  C.  James  (1756-1835)  was  the  first  distinct 
teacher  of  obstetrics,  his  chair  falling  later  to  Dewees, 
already  mentioned,  who  wrote  extensively  on  midwifery^ 
and  the  diseases  of  children  and  of  women.  The  same 
chair  in  the  University  of  Pennsylvania  was  filled 
later  by  Hugh  L.  Hodge  (1796-1873),  a  man  of  great 
originality  and  independence,  who  published  a  most 
elaborate  and  beautiful  work  upon  his  branch,  which 
will  always  remain  a  classic.  Charles  D.  Meigs,  professor 
in  the  Jefferson  School,  Philadelphia,  was  the  first  to 
direct  attention  to  thrombosis  as  a  cause  of  sudden  death 
in  childbirth.  He  wrote  both  on  gynaecology  and  mid- 
wifery. Bedford,  of  Baltimore,  was  another  popular 
teaclier  and  writer,  with  whom  deserves  to  be  mentioned 
William  H.  Byford,  of  Chicago,  who  wrote  on  both 
obstetrics  and  gynaecology. 

Gynaecology  owes  much  to  the  efforts  of  American 
schools  and  practitioners.  The  first  successful  attempt  of 
McDowell's,  already  alluded  to,  was  imitated  by  Nathan 
Smith  in  1821  ;  and  during  the  next  forty  years  thirty-six 
ovariotomies    had    been    performed  by  eighteen    different 


296 


THE   HISTORY    OF    MEDICINE. 


surgeons,  with  a  record  of  twenty-one  recoveries.  Prob- 
ably the  most  prominent  passed  figure  in  American  gynae- 
cology is  J.  Marion  Sims  (1813-1883),  born  in  the  South, 
where  he  invented  his  well-known  speculum  in  1852, 
whose  introduction  marked  an  epoch  in  the  treatment  of 
the  pelvic  diseases  of  women.  It  was  also  in  South  Caro- 
lina, among  poor  negro  patients,  that  he  perfected  his 
method  of  plastic  operations  in  the  vagina  for  the  relief  of 


Fig.  .32.— J    Mariox  sms,  M.D. 


vesical  fistulse,  which  he  later  demonstrated  in  Paris  to  the 
astonishment  of  incredulous  Parisian  surgeons,  who  had 
almost  uniformly  failed  in  their  attempts,  and  which  he 
later  successfully  and  brilliantly  performed  in  all  the  cap- 
itals of  Europe,  where,  as  in  this  countiT,  he  enjoyed  the 
greatest  reputation.  He  was  the  founder  of  the  great 
Woman's  Hospital  in  New  York,  in  1855,  an  institution 
from  which  has  proceeded  more  good  gynaecological  teach- 
ing than  from  any  similar  institution  in  tlie  world      Other 


NOTABLE   AMERICAN    SURGEONS.  297 

ovariotomists  and  gyneecologists  of  great  merit  were  John 
L.  Atlee,  and  his  brother  Washington  Atlee,  of  Pennsyl- 
vania ;  Dunlap,  of  Springfield,  Ohio  ;  Peaslee,  of  New 
York,  who  wrote  the  first  American  treatise  on  ovarian 


Fig.  53.— D.  Hayes  Agnew,  M.D.,  LL.D. 
(From  an  oil  painting  of  1890  in  the  College  of  Pliysicians,  Philadelphia.) 

tumors;  Kimball,  of  l.owell,  Massachusetts;  and  D.  H. 
Agnew,  of  Philadelphia,  who  is,  perhaps,  yet  better  known 
as  a  general  surgeon  because  of  his  mag^mm  oj)us, — his 
Treatise  on  SiLrgery,  in  three  large  volumes,  already 
mentioned. 


298  THE    HISTORY    OF    MEDICINE. 

After  this  brief  resume  of  the  names  and  achievements 
of  the  best-known  American  physicians  and  surgeons  no 
longer  living,  it  remains  only  to  say  a  few  words  with 
regard  to  the  general  character  of  their  work  and  attain- 
ments. It  certainly  was  the  case,  during  the  earlier  and 
middle  portions  of  this  century,  that  men  had  mucli  to 
gain,  beside  addition  to  their  vernacular,  by  study  in  foreign 
countries.  Edinburgh  and  London  were,  at  first,  the  centres 
to  which  men  flocked ;  during  the  middle  of  the  century 
they  gathered  in  Paris,  attracted  by  such  men  as  Broussais, 
Velpeau,  and  others ;  after  which  the  tide  of  travel  turned 
toward  Germany,  wliere  the  government  does  more  for  the 
education  of  medical  men  and  the  furnishing  of  distinct 
opportunities  than  is  done  in  any  other  part  of  the  world. 
But,  thanks  to  the  influence  of  the  foreign  schools  and  the 
receptivity  and  natural  quickness  of  the  American  mind, 
we  have  reached  a  point  in  this  country  wlien  it  is  no 
longer  necessary  for  American  students  to  visit  the  foreign 
centres  for  this  purpose,  advantageous  as  these  may  be  in 
many  respects.  The  only  feature  in  which  we  are  yet  lack- 
ing is  the  matter  of  government  aid  and  the  government 
control  of  medical  institutions,  by  which  better  opportu- 
nities may  be  aflbrded  for  pathological  study.  Aside  from 
this,  and  the  centralization  of  cases  which  government 
control  permits,  it  may  be  said  that  the  Americans  are  in 
all  respects  as  good  practitioners  as — and  in  most  respects 
better  than — their  foreign  colleagues.  They  evince  more 
of  humanity,  more  of  real  interest  and  care  in  their 
patients,  and  more  consideration  for  their  comfort  and 
welfare ;  while,  in  all  that  pertains  to  fertility  of  invention, 
to  originality  of  performance,  and  accuracy  of  work,  they, 
as  a  rule,  excel.  Divested  of  glamour,  American  surgery, 
both  general  and  special,  is  aliead  of  most  of  that  which 
one  can  see  abroad,  and  the  therapeutics  of  the  American 
profession  certainly  surpass  those  of  any  other  nationality. 
No  one  need  feel,  then,  that  it  is  necessary  to  go  abroad  for 


AMERICAN    TEACHING    OF    TO-DAY.  299 

any  purpose,  unless  it  may  be  that  polish  and  wide  range 
of  general  information  that  necessarily  come  from  travel 
and  observation  among  other  nations  and  peoples.  In 
practical  medicine,  then,  as  in  practical  living,  America 
leads  the  world. 


CHAPTER  XII. 

THE    HISTORY    OF    ANAESTHESIA. 

Anaesthesia  and  Analgesia.  Drugs  Possessing  Xarcotic  Projierties  in  use  since 
Prehistoric  Times.  Mandragora  ;  Hemp  ;  Hasheesh.  Sulphuric  Ether  and 
the  Men  Concernetl  in  its  Introduction  as  an  Aniesthetic — Long,  Jackson, 
"Wells,  and  Morton.  Morton's  First  Public  Demonstration  of  the  Value  of 
Ether.  Morton  Entitled  to  the  Credit  of  its  Introduction.  Chloroform 
and  Sir  James  Simpson.     Cocaine  and  Karl  Roller. 

It  is  not,  perhaps,  generally  understood  that  we  owe 
the  term  ancesthesia  and  the  adjective  ancesthetic  to  the 
genius  of  Dr.  Oliver  AVendell  Holmes,  who  suggested 
their  use  to  Dr.  Morton.  The  term  ancesthesia  is  ap- 
plied to  the  artificial  loss  or  deprivation  of  all  sensation, 
which  may  be  either  local  or  general.  It  should  be  dis- 
tinguished from  analgesia^  which  means  simply  freedom 
from  pain,  consciousness  being  retained.  In  this  respect 
local  anaesthesia  is  really  local  analgesia,  although  the 
terms  are  confused  in  this  regard. 

Anaesthesia,  in  its  present  sense,  is  truly  a  modern  dis- 
covery, which  is  to  be  credited  to  the  United  States.  In 
its  less  restricted  sense,  however,  it  is  a  condition  brought 
about  by  numerous  drugs, — intoxicants,  narcotics,  etc., — 
some  of  which  have  been  more  or  less  in  use  for  centuries. 
Anaesthesia  is  also  a  condition  wliich  may  be  produced  in 
tlie  hypnotic  sleep, — a  fact  well  recognized  by  the  ancients, 
although  the  attention  of  scientific  men  was  scarcely  drawn 
to  the  fact  until  the  days  of  the  notorious  Mesmer.  The 
substances  which  may  produce  loss  of  consciousness  may 
be  taken  intentionally  or  unintentionally,  and  may  be  taken 
into  the  stomach,  beneath  the  skin,  or,  when  gaseous, 
through  the  lungs,  in  which  absorption  of  the  same  into 
the  blood  is  very  speedy.  It  is  not  at  all  unlikely  that  the 
curious  effects  ascribed  to  some  of  the  ancient  oracles  were 
(300) 


NEPENTHE.       MANDRAGOKA.       HASHEESH.  301 

due  to  the  iulialation  of  gases  arising  from  natural  springs 
or  produced  from  other  sources. 

The  most  common  source  of  narcotic  drugs  has  always 
been  the  vegetable  kingdom ;  and  the  peculiar  effects  of 
the  juices  or  other  ingredients  of  the  poppy,  henbane, 
deadly-nightshade,  Indian  hemp,  mandragora,  etc.,  have 
been  sung  in  poetry,  rehearsed  in  prose,  and  known  from 
almost  prehistoric  time.  Ulysses  and  his  companions  were 
stupefied  by  nepenthe ;  a  draught  of  vinegar  and  myrrh, 
or  gall,  was  ottered  to  Christ  upon  the  cross,  as  it  often 
was  to  malefactors ;  and  Herodotus  speaks  of  a  peculiar 
habit  of  the  Scythians,  who  produced  some  stupefying 
vapor, — probably  from  the  seed  of  the  hemp.  From  Bib- 
lical times,  at  least,  the  most  common  narcotic  seems  to 
have  been  alcohol  in  some  of  its  numerous  combinations. 
Furthermore,  the  effect  of  hemlock  has  been  celebrated 
since  the  days  of  Socrates,  who  was  permitted  to  drink  it 
in  order  to  soothe  himself  during  his  last  hour. 

Mandragora  seems  to  have  had  a  great  reputation  in 
times  past, — so  much  so  that  it  is  probable  that  more  than 
one  substance  was  included  under  this  term.  Apuleius, 
who  lived  about  a  century  later  than  Pliny,  wrote :  "  If 
any  one  is  to  have  a  member  mutilated,  burned,  or  sawed, 
let  him  drink  half  an  ounce  of  mandragora  with  wine, 
and  let  him  sleep  till  the  member  is  cut  away,  without  any 
pain  or  sensation."  Among  the  Chinese  and  the  Indians 
similar  drugs  seem  to  have  been  in  frequent  use,  especially 
the  bJiang,  ordinarily  known  as  hasheesh.  In  many  parts 
of  the  East  sometliing  of  this  kind  was  administered  to 
condemned  criminals,  as  well  as  those  compelled  to  undergo 
rude  operations.  It  is  said,  also,  that  mild  intoxication 
was  produced  among  the  fanatics  of  the  East  for  the  pur- 
pose of  firing  them  to  the  point  of  heroic  deeds,  as  it  is 
also  said  that  Jimong  the  Druids  the- practice  prevailed  of 
partially  stupefying  the  novitiates  before  initiating  them 
into  tbe  most  sacred  and  secret  rites  of  their  cult. 

COLLLH-l 


802  THE   HISTORY    OF    MEDICINE. 

Guy  de  Chauliac  was  almost  the  only  surgical  writer 
of  previous  centuries  who  has  retened  to  agents  for  the 
relief  of  pain,  although  during  and  before  his  time  it  was 
customary  to  give  something  to  those  about  to  undergo 
torture,  by  which  to  deaden  their  sensibiHty ;  and,  though 
in  the  fables  of  all  lands  and  all  times  something  has 
always  figured  to  which  was  ascribed  the  power  of  making 
people  oblivious  to  pain  or  to  the  peculiarities  of  their 
situation,  it  is  very  difficult  to  learn  just  what,  if  any,  par- 
ticular composition  was  referred  to  or  deserved  such  men- 
tion. There  is  allusion  to  something  of  tlie  kind  in  Romeo 
and  Juliet ;  again,  in  Cymheline  ;  and  in  one  of  Middle- 
ton's  tragedies,  published  in  1567,  entitled  Women  Beioare 
Women^  occurs  this  passage : — 

"I'll  imitate  the  pities  of  old  surgeons 
To  this  lost  limb,  who,  ere  they  show  their  art, 
Cast  one  asleep,  then  cut  the  diseased  part." 

LaiTey,  in  his  military  campaigns,  noticed  the  effect  of 
cold  in  diminishing  sensitiveness,  and  suggested  that  cold 
might  be  made  a  useful  local  anaestlietic.  Many  surgeons 
used  to  operate  upon  patients  under  the  influence  of 
alcoholic  narcotization.  It  was  in  1776  that  Mesmer 
arrived  in  Paris  and  became  the  exponent  of  so-called 
"animal  magnetism," — later  termed  "mesmerism,"  now 
known  as  hypnotism, — under  the  influence  of  which  he 
reduced  to  the  state  of  unconsciousness  of  pain  (i.e., 
analgesia,  as  well  as  the  more  complete  condition,  anaes- 
thesia) a  number  of  patients,  who  were  operated  upon 
without  feeling  the  slightest  suffering. 

But,  in  spite  of  the  earnest  attempts  of  humane  surgeons 
in  various  parts  of  the  world,  no  agent  liad  been  discovered 
wliich  was  proven  safe  and  generally  effectual,  up  to  the 
time,  for  instance,  of  Velpeau,  who  in  1839  wrote:  "To 
escape  pain  in  surgical  operations  is  a  chimera  which  we 
are  not  permitted  to  look  for  in  our  time." 

The    substance   known  as   sulpliuric    ether    has   been 


SULPHURIC    ETHER    NOT    A    RECENT    DISCOVERY.         303 

known  since  the  thirteenth  century,  when,  as  it  appears, 
Raymond  Lulli  made  certain — perhaps  ambiguous — 
references  to  it.  In  1540  it  was  known  as  the  sweet  oil 
of  vitriol.  It  was  not  called  an  ether  until  1730,  when 
Godfrey  spoke  of  it  as  such.  It  was  frequently  referred 
to  during  the  last  century  by  various  writers,  and  the  first 
reference  to  its  inhalation  seems  to  have  been  published  in 
1795  by  Pearson.  In  a  work  by  Beddoes,  on  Factitious 
Airs,  published  at  Bristol,  in  1796,  is  a  statement  that 
"  Ether  in  pectoral  catarrh  gives  almost  immediate  relief, 
both  to  the  oppression  and  pain  in  the  chest."  Beddoes 
also  states  that  after  inhaling  two  spoonfuls  he  soon  fell 
asleep.  Later  it  was  in  somewhat  general  use  internally 
for  mitigating  the  pains  of  colic.  By  1812  it  was  often 
inhaled  for  experiment  or  diversion,  its  peculiar  exhilarating 
effects  being  generally  knov»^n.  So  it  is,  perhaps,  not 
strange  that  so  soon  as  it  was  definitely  recommended 
for  purposes  of  surgical  ansesthesia,  a  number  of  claimants 
for  the  honor  of  its  discovery  should  quickly  arise. 

It  was  the  same  with  nitrous-oxide  gas,  which  had 
been  known  for  a  number  of  years,  and  which  was 
repeatedly  used  for  the  purpose  of  anaesthesia  before  the 
introduction  of  ether  for  the  same  purpose. 

Chloroform  was  discovered  in  the  year  1831  by 
Guthrie,  of  Sackett's  Harbor,  New  York,  and  about  the 
same  time  by  Soubeiran,  in  France,  and  Liebig,  in 
Germany.  But,  although  before  the  profession  for  sixteen 
years,  it  was  not  recommended  for  the  same  purpose  as 
sulphuric  ether  until  1847,  and  j;hen  by  Doctor — later, 
Sir — James  Simpson. 

For  all  practical  purposes  we  may  limit  further  con- 
sideration of  the  history  of  anaesthesia  to  these  three 
substances,  and  mainly  to  the  consideration  of  the  intro- 
duction and  adoption  of  ether,  which  displaced  nitrous 
oxide,  preceded  chloroform,  and  has  held  its  own  to  the 
present  day  as  the  anaesthetic  in  most  general  use,  although 


304  THE    HISTORY    OF    MEDICINE. 

in  many  respects  inferior  to  chlorol'orm.  But  the  glamour 
of  liistory  pertains  mostly  to  ether,  because  of  the  peculiar 
difficulties  and  incidents  attending  its  production. 

For  the  honor  of  its  discovery  there  are  four  claimants: 
— Crawford  W.  Long,  of  Danielsville,  Ga. ;  Charles  T. 
Jackson,  of  Plymouth,  Mass., — both  physicians;  Horace 
Wells,  of  Hartford,  Vt.,  and  William  T.  G.  Morton,  of 
Charleston,  Mass., — both  dentists.  It  is  only  fair  to  each 
of  these  four  men  to  consider  briefly  the  merits  of  the 
claims  made  for  each,  while  at  the  same  time  attributing 
the  final  success  of  the  new  agent  to  the  happy  accidents 
which  permitted  Morton  to  make  a  public  demonstration 
of  its  power  in  the  Massachusetts  General  Hospital, 
before  such  eminent  men  as  Warren,  Bigelow,  and  others, 
by  whose  influence  and  reputation  the  agent  was  at  once 
received  upon  its  merits.  This  was  on  the  sixteenth  of 
October,  1846, — a  year  which  deserves  to  be  memorable 
in  the  history  of  medicine. 

Crawford  Long  graduated,  in  1839,  from  the  medical 
department  of  the  University  of  Pennsylvania,  and  settled 
in  Jefl"erson,  Georgia,  where  it  seems  to  have  been  a 
common  thing  to  have  what  was  known  as  "  ether  frolics," 
during  which  the  exhilarating  efl'ects  of  the  inhalation  of 
the  drug  were  matters  of  common  sport  and  amusement  at 
various  small  gatherings.  Long  himself  frequently  inhaled 
the  drug  and  often  felt  its  benumbing  efl'ects.  It  is  stated 
that  it  finally  occurred  to  him  to  give  it  a  trial  in  a  surgi- 
cal operation,  and  that,  in  March  of  1842,  he  removed  a 
small  tumor  from  the  iv?ck  of  a  patient  thus  anaesthetized 
and  without  any  pain.  Owing  to  the  sparseness  of  the 
population  and  tlie  lack  of  dissemination  of  medical 
knowledge  in  those  days,  no  public  report  was  made  of 
these  operations,  which  produced  nothing  more  than  local 
town-talk.  A  young  student  of  Long's,  named  Wilhite, 
kept  a  negro  boy  under  the  influence  of  ether  for  some 
time,  to  Long's  surprise.     Long  lived  one  hundred  and 


CLAIMS   OF   LOKG    AND    WELLS.  305 

thirty  miles  from  any  railroad,  and  the  first  published 
account  of  his  operations  appeared  in  1849,  which  was 
suggested  by  an  account  of  Morton's  work,  which  he  had 
read  in  the  editorials  of  the  Medical  Examiner  for  Decem- 
ber, 1846.  Long  died  in  1878,  the  unfortunate  contro- 
versy in  which  the  four  claimants  already  mentioned  par- 
ticipated being  not  yet  concluded.  Nevertheless,  there  is' 
every  reason  to  think  that  he  is  entitled  to  the  credit  of 
having  first  anaesthetized  a  patient  with  sulphuric  ether  for 
the  purpose  of  producing  insensibility  to  pain. 

Horace  Wells  began  the  study  of  dentistry  in  1834,  in 
Boston,  and  later  opened  an  ofiice  in  Hartford,  Connecti- 
cut. He  seems  to  have  been  a  young  man  of  great  inge- 
nuity, continually  making  new  instruments  and  devising 
new  experiments.  To  him  is  to  be  credited  the  first  opera- 
tion ever  performed  without  pain  by  the  use  of  nitrous- 
oxide  gas.  In  1844  a  Dr.  Colton  delivered  a  lecture  in 
Plartford  upon  the  subject  of  this  gas.  A  young  man  who 
inhaled  it,  and  became  excited,  ran  against  some  furniture, 
badly  bruising  himself,  but  made  no  complaint  of  pain. 
Wells,  noticing  this,  said  to  a  by-stander  that  he  believed 
that  one,  by  inhaling  a  sufficient  quantity,  could  have  a 
tooth  extracted  or  a  leg  amputated  without  pain.  The 
following  day  he  inhaled  the  gas  himself  and  had  a  tooth 
extracted  by  a  Dr.  Riggs.  Wells  remained  unconscious  for 
a  little  while,  and,  on  recovering  consciousness,  cried  out: 
"  A  new  era  in  tooth-pulling !  It  did  not  hurt  me  as  much 
as  the  prick  of  a  pin  !  It  is  the  greatest  discovery  ever 
made !  " 

He  at  once  began  the  manufacture  and  use  of  the  gas, 
which  became  quite  general  in  that  locality.  His  attention 
was  also  called  to  the  action  of  the  vapor  of  ether,  which 
Dr.  Marcy,  a  physician  of  Hartford,  suggested  to  him  to 
try  as  a  substitute  for  gas;  but  Wells,  finding  it  more 
difficult  to  administer,  discontinued  it  and  confined  himself 
to  the  use  of  nitrous  oxide.     A  month  later  Dr.  jMarcv 


306  THE    HISTORY   OF   MEDICINE. 

gave  ether  to  a  sailor  for  a  small  operation,  the  man  feeling 
no  pain.  These  experiences  of  Wells  and  Marcy  occurred 
two  years  after  Long's  work  with  ether,  each  being  in  total 
ignorance  of  tlie.  experiments  of  the  other. 

In  1845  AVells  visited  Boston  for  the  purpose  of  intro- 
ducing nitrous  oxide  as  an  anaesthetic,  and  called  upon 
liis  fellow-dentist  and  old  partner,  Morton,  among  others. 
He  was  discouraged,  witli  his  lack  of  success,  returned  to 
Hartford,  and  continued  the  frequent  use  of  gas  for  a 
couple  of  years  longer,  but  met  with  no  encouragement  in 
introducing  it  for  general  surgical  purposes,  on  account  of 
prejudice  and  fear  upon  the  part  of  physicians  and  sur- 
geons. Wells  died  in  January,  1848,  a  few  days  before 
the  Medical  Society  of  Paris  passed  a  resolution  that  to  him 
is  due  all  the  honor  of  having  first  discovered  and  success- 
fully applied  the  use  of  vapors  or  gases  whereby  surgical 
operations  could  be  performed  without  pain.  There  stands 
to-day  in  Hartford  the  monument  erected  by  the  city  and 
the  State,  with  the  following  inscription : — 

"  Horace  Wells,  who  discovered  ansesthesia,  November,  1844." 

William  T.  G.  Morton  was  born  in  1819,  and,  after 
failing  in  business  in  Boston,  in  1840  went  to  Baltimore 
and  studied  dentistry.  In  1841  he  entered  the  office  of 
Horace  Wells,  above  alluded  to,  as  assistant,  and  in  1842 
became  his  partner,  after  having  introduced  a  new  kind  of 
solder  for  fixation  of  artificial  teeth  to  gold  plates.  In 
1843  this  partnership  was  dissolved,  Wells  moving  to 
Hartford,  while  Morton,  in  1844,  entered  the  office  of 
Dr.  C.  P.  Jackson  as  a  medical  student,  matriculating 
in  the  Harvard  School,  but  never  graduating.  After 
Wells's  visit  to  Boston,  during  wliicli  he  tried  to  introduce 
"  laughing  gas,"  Morton  and  he  had  numerous  interviews, 
especially  with  regard  to  this  gas.  Morton  was  not  well 
versed  in  chemistry,  and  sought  the  advice  of  his  medical 
preceptor,  Jackson,  with  regard  to  its  manufacture.     Asking 


MORTON    THE   PROMOTER   OF   ETHER    ANESTHESIA.       307 

why  Morton  wished  to  make  it  and  being  told  the  reason, 
Jackson  suggested  the  use  of  sulphuric  ether,  just  as  Marcy 
had  suggested  its  use  to  Wells,  saying  that  it  was  easy  to 
procure,  safe  in  employment,  and  equally  productive  of 
results.  He  also  stated  that  the  students  at  Cambridge 
College  often  inhaled  ether  for  amusement.  On  the  even- 
ing of  the  same  day,  September  30,  1846,  Morton  admin- 


tna.  54.— William  T.  G.  Morton,  M.D. 


istered  ether  for  the  extraction  of  a  tooth,  the  patient  stating 
that  he  had  felt  no  pain.  On  the  following  day  he  visited 
the  office  of  a  well-known  patent  lawyer  for  the  purpose  of 
securing  letters  patent  upon  his  supposed  discovery.  This 
lawyer,  learning  of  Jackson's  connection  with  the  subject, 
took  time  to  consider  the  matter,  consulted  with  Jackson, 
and  came  to  the  conclusion  that  the  patent  must  be  a  joint 
affair,  neither  one  having  exclusive  right  to  claim  it.     But 


308  THE   HISTORY   OF   MEDICINE. 

Jackson,  fearing  the  censure  of  the  Massachusetts  Medical 
Society  should  his  name  be  connected  with  the  patent,  and 
Morton — as  a  dentist — having  no  such  fine  scruples,  it  was 
agreed  that  the  patent  should  be  made  out  in  the  names  of 
both,  but  that  Jackson  was  to  at  once  assign  his  interest 
to  Morton ;  in  return  for  which  he  was  to  receive  a  ten  per 
cent,  commission.  Meantime  Morton  called  upon  Warren, 
one  of  the  surgeons  in  the  Massachusetts  General  Hospital, 
who  promised  his  co-operation  and  sent  him  an  invitation 
to  test  his  invention  in  the  hospital  on  October  16,  1846. 
Tlie  clinic-room  was  filled  when  Morton  placed  the  patient 
under  the  influence  of  his  letheon,  as  he  had  named  it ; 
after  which  Warren  removed  a  tumor  from  the  neck  of  a 
young  man,  and,  as  it  appeared,  without  pain.  Upon  the 
following  day  another  operation  was  performed  upon  a 
young  woman,  with  the  same  happy  result,  while  on  No- 
vember 7th  an  amputation  was  made,  entirely  painlessly. 
At  this  time  Morton  endeavored  to  disguise  the  odor  of  the 
substance  he  was  using  by  aromatic  oils.  It  was  not 
until  the  staff  of  the  Massachusetts  General  Hospital  de- 
clined to  use  an  agent  whose  composition  was  kept  secret 
that  Morton  revealed  publicly  the  fact  that  this  was  nothing 
but  sulphuric  ether  disguised  by  aromatics.  From  a  report 
of  the  Commissioner  of  Patents,  published  a  little  later,  the 
following  paragraph  is  taken,  the  report  being  in  the  nature 
of  a  commentary  upon  the  discovery: — 

"  It  has  been  known  for  many  years  that  the  vapor  of 
sulphuric  ether,  when  freely  inhaled,  would  intoxicate  to 
the  same  extent  as  alcohol  when  taken  into  the  stomach. 
.  .  .  The  fact  has  stood,  further,  upon  the  pages  of 
science  for  many  years  that  the  inhalation  of  sulphuric 
ether  was  productive  of  temporary  narcotic  stimulant 
effects." 

After  the  issuance  of  letters  patent  Morton  began  sell- 
ing office-rights,  such  being  the  custom  then,  as  now, 
among  the  dental  profession,  who  are  much  more  commer- 


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310  THE   HISTORY    OF   MEDICINE. 

cial  in  their  proclivities  than  their  brethren  of  the  medical 
profession.  The  result  was  an  almost  endless  litigation, 
with  the  development  of  the  greatest  personal  animosity 
and  rivalry  between  Jackson  and  Morton,  as  well  as  the 
friends  and  descendants  of  the  other  claimants.  Morton 
wrecked  his  fortune  and  ruined  his  health  in  his  efforts  to 
get  substantial  recognition  and  remuneration  from  the 
United  States  Government;  and  the  history  of  his  repeated 
attempts  to  interest  Congress  and  the  various  officials  of 
the  government,  from  the  president  down,  is  instructive, 
but  far  from  pleasing,  reading.  In  these  attempts  lie  prac- 
tically failed,  and  died  from  an  illness  contracted  through 
exposure,  after  maddening  disappointment,  although  he 
had  been  the  recipient  of  numerous  honors  and  some 
small  pecuniary  recognition  from  societies  and  individuals. 
Morton  died  in  1868.  In  reviewing  the  history  of  his  life 
and  labors  there  is  much  to  justify  the  inscription  upon 
the  monument  erected  to  his  memory  at  Mount  Auburn 
Cemetery,  Boston : — 

"  Inventor  and  revealer  of  anaesthetic  inhalation,  before  vrhom  in 
all  time  surgery  was  agony,  and  by  whom  pain  in  surgery  was  averted 
and  annulled  ;  since  whom  science  has  controlled  pain." 

Charles  T.  Jackson  graduated  at  Harvard  Medical 
College  in  1829,  after  having  led  an  already  eventful 
career  as  geologist  and  mineralogist.  He  spent  several 
years  abroad,  meeting  many  of  the  most  distinguished  men 
upon  the  Continent  and  displaying,  in  many  ways,  a  great 
deal  of  scientific  talent  and  mechanical  inj^enuitv.  In 
1835  he  opened,  in  Boston,  the  first  laboratory  for  teach- 
ing analytical  chemistry  in  the  United  States.  A  year 
later  he  was  made  State  Geologist  of  Maine,  and  spent 
three  years  in  this  capacity.  He  also  did  a  great  deal  of 
work  upon  the  State  geological  surveys  of  Rhode  Island, 
New  Hampshire,  and  New  York,  while  he  was  the  first  to 
call  attention  to  the  mineral  resources  of  the  southern 
shore  of  Lake   Superior,  where,  in    1845,  he  opened  up 


JACKSON  S   CLAIMS.  311 

copper  and  iron  mines.  In  1846  and  1847  lie  became 
deeply  interested  in  the  subject  and  discovery  of  anaes- 
thesia, and  after  the  successful  introduction  of  ether  by 
Morton,  in  the  Massachusetts  General  Hospital,  set  up  the 
claim  that  it  was  he  who  had  suggested  it  to  Morton.  In 
a  pamphlet,  published  a  little  later,  he  states :  "  In  the 
year  1837  I  discovered  that  ether- vapor  was  superior  to 
alcohol  as  a  remedy  for  the  strangling  and  toxic  effects  of 
chlorine-gas  after  inhalations  for  that  purpose  in  my  labo- 
ratory." He  then  relates  how  he  administered  the  vapor 
to  himself  for  the  relief  of  the  irritation  produced  by  in- 
haling chlorine,  and  describes  his  sensations  upon  going  to 
sleep  and  awakening.  This  claim  in  its  entirety  was  a 
great  surprise  to  both  Morton  and  Wells,  and  led  to  a 
most  unseemly  discussion,  which  degenerated  into  a  down- 
right professional  fight.  After  the  death  of  Wells,  Jackson 
and  Morton  both  claimed  that  nitrous-oxide  gas  was  not 
an  anaesthetic,  and  that  insensibility  to  pain  could  not  be 
produced  by  it,  in  consequence  of  which  the  use  of  the 
gas  was  quite  discontinued.  It  became,  then,  simply  a 
question  of  priority  as  to  tlie  administration  of  ether  for 
relief  of  pain  during  surgical  operations.  Wells  being 
dead,  this  brought  Long  into  the  conflict.  Jackson  visited 
Europe  again,  and  presented  his  claim  before  numerous 
societies  in  such  a  way  as  to  be  recognized  abroad  as  the 
discoverer  of  anaesthesia.  The  relative  merits  of  the  whole 
controversy  appear  to  have  been  pretty  well  summed  up  in 
a  memorial  sent  to  the  Senate  and  House  of  Representa- 
tives by  several  liundred  members  of  the  Massachusetts 
Medical  Society,  which  contains  the  following  paragraph : — 
"The  undersigned  hereby  testify  to  your  honorable 
bodies  that,  in  their  opinion,  AVilliam  T.  G.  Morton  first 
proved  to  the  world  that  ether  would  produce  insensibility 
to  the  pain  of  surgical  operations,  and  that  it  could  be 
used  with  safety.  In  their  opinion,  his  fellow-men  owe  a 
debt  to  him  for  tl-.is  knowledge," 


312  TBE  BISnMiT  OF  MEDICIIPE. 

In  the  Public  Garden  in  Boston  there  has  been  erected 
a  monoment  to  the  memory  of  the  discoTerer  c^  ether,  the 
donor  being,  at  the  time,  unaUe  to  moition  the  indiTidaal 
to  whom  it  should  be  dedicated.  Upon  one  fiuse  is  this 
inscription : — 


'-^  To  coMMMfloie  «ke  dinorarjr  tfcat  tlw  iddn^  «( 
JiwfBhilitr  to  fn%  taslk  pravca  to  tke  worid  at  tihe 
6cMnl  Ha^ital,  m  Borton,  October,  ISML" 

Upon  another  lace  are  these  words : — 

'^  !■  gntitode  for  tke  idkf  of 
of  tAa  M  dtoHi  of  PoBtoB  ka»  crcctod 
Tkegifkof  TkammJjtt." 


Morton's  untimely  death,  largely  doe  to  disappoint- 
ment and,  as  he  thouglit,  to  persecution,  has  been  already 
mentioned.  In  1873  Jackson's  mind  became  deruiged, 
and  he  died  in  an  asylum  in  1880. 

Sir  James  Paget  has  summed  up  the  relatire  claims  of 
our  four  contestants  in  an  article  entitled  ^Escape  firom 
Fain,"  published  in  the  Xineteenih  CaUttry  for  December, 
1879.  He  says:  '•  While  Long  waited  and  Wdls  turned 
back  and  Jackson  was  thinking,  and  those  to  whom  they 
had  talked  were  neither  acting  nor  thinking,  Morton,  the 
practical  man,  went  to  work  and  worked  resolutely.  He 
gare  ether  successfully  in  serere  surgical  operations,  he 
loudly  proclaimed  his  deeds,  and  he  compelled  mankind 
to  hear  him."  As  Dr.  Morton's  son.  Dr.  W.  J.  Morton, 
of  New  Tork,  says,  wlien  writing  of  his  fiither's  claim : 
^  Men  used  steam  to  propel  boats  before  Fulton,  electiicity 
to  couTey  messages  before  Morse,  Taccine-Tims  to  aTcrt 
small-pox  before  Jenner,  and  ether  to  annul  pain  before 
Morton." 

So  mnch  for  ether.  I  hare  already  stated  that  chloro- 
forro  was  discoTered  by  Guthrie  in  1831.  But,  though 
discorered  in  this  conntry,  it  was  first  introduced  as  an 
anaesthetic  agent  in  Scotland,  by  iKmpson,  who,  in  1847, 
at  the  age  of  thirty-six,  b^;an  to  direct  his  attention  to  the 


SIMPSON  S    INTRODUCTION    OF   CHLOROFORM.  313 

discovery  of  some  means  of  alleviating  pain  during  child- 
birth, having  a  very  large  obstetric  practice.  Simpson  was 
not  satisfied  with  sulphuric  ether,  because  of  its  strong 
and  disagreeable  odor,  and  inquired  of  his  friend  Waldie, 
Master  of  Apothecaries'  Hall,  of  Liverpool,  if  he  knew 
of  nothing  likely  to  be  a  satisfactory  substitute.  Waldie, 
acquainted  with  the  chemical  composition  of  chloric  ether, 
suggested  that  chloroform  be  prepared  from  it  and  used. 
Simpson  experimented  with  this  in  1847,  and  established 
its  anaesthetic  properties,  which  he  made  known  through 
a  paper  read  on  November  10th  of  the  same  year.  It  was 
arranged  that  upon  the  13th  of  the  month  a  public  test 
should  be  made  at  tlie  Royal  Infirmary ;  but  Simpson, 
who  was  to  administer  the  chloroform,  was  unavoidably 
detained.  Accordingly  the  operation  was  performed  as  of 
yore,  without  an  anaesthetic,  and  during  its  performance 
the  patient  died  upon  the  table.  Had  this  death  taken 
place  during  the  employment  of  chloroform,  it  would  have 
been  the  death-blow  of  that  substance  as  an  ansesthetic. 
The  first  public  trial  took  place  two  days  later,  the  test 
proving  a  great  success.  Simpson  goes  down  in  history, 
then,  not  as  the  discoverer  of  anaesthesia,  but  as  the  one 
who  introduced  chloroform  for  anaesthetic  purposes.  He 
died  in  1870,  and  upon  his  bust  in  Westminster  Abbey  is 
this  inscription  : — 

"To  whose  genius  and  benevolence  the  world  owes  the  blessings 
derived  from  the  use  of  chloroform  for  the  relief  of  suffering." 

It  is  a  bit  of  most  interesting  medical  history  that  after 
Simpson's  announcement  of  his  discovery  he  was  violently 
and  vehemently  opposed  by  the  Scottish  clergy,  who  reviled 
him  for  endeavoring  to  relieve  the  pains  of  childbirth, 
basing  their  opposition  upon  the  primeval  curse:  "In 
sorrow  shalt  thou  bring  forth  children."  And  the  beau- 
tiful ease  with  which  Simpson  refuted  this  childish 
sophistry  must  ever  be  memorable ;  for  with  one  short 
argument  he  silenced  his  opponents  and  turned  upon  them 


314  THE    HISTORY    OF    MEDICINE. 

the  ridicule  of  the  entire  profession.  For  he  reminded 
them  that  the  first  operation  recorded  in  history  was  per- 
formed under  anaesthesia,  since,  wlien  God  created  Eve 
from  one  of  Adam's  ribs,  he  "  caused  a  deep  sleep  to  fall 
upon  Adam." 

Cocaine  is  now  such  a  universally  recognized  local 
anaesthetic  that  there  is  the  best  of  reason  for  referring  to 
it  here — the  more  so  because  it  affords  another  opportunity 
to  do  honor  to  a  discoverer  who  has  rendered  a  most  im- 
portant service  not  only  to  our  profession,  but  to  the  world 
in  general. 

The  principal  active  constituent  of  coca-leaves  was  dis- 
covered about  1860  by  Niemann,  and  called  by  him 
cocaine.  It  is  an  alkaloid  which  combines  with  various 
acids  in  the  formation  of  salts.  It  has  the  quality  of  be- 
numbing raw  and  mucous  surfaces,  for  which  purpose  it 
was  applied  first  in  1862  by  Sclirotf  and  in  1868  by 
Moreno.  In  1880  Van  Aurap  hinted  that  this  property 
might  some  day  be  utilized.  Karl  Koller  logically  con- 
cluded from  what  was  known  about  it  that  this  anaesthetic 
property  could  be  taken  advantage  of  lor  work  about  the 
eye,  and  made  a  series  of  experiments  upon  the  lower 
animals,  by  which  he  establislied  its  efficiency  and  made  a 
brilliant  discovery.  He  reported  his  experiments  to  the 
Congress  of  German  Oculists,  at  Heidelberg,  in  1884, 
News  of  this  was  transmitted  with  great  rapidity,  and 
within  a  few  weeks  tlie  substance  was  used  all  over  the 
world.  Its  use  spread  rapidly  to  other  branches  of  sur- 
gery, and  cocaine  local  anaesthesia  became  quickly  an 
accomplished  fact.  More  time  was  required  to  point  out 
its  disagreeable  possibilities,  its  toxic  properties,  and  the 
like,  but  it  now  has  an  assured  and  most  important  place 
among  anaesthetic  agents,  and  has  been  of  the  greatest  use 
to  probably  ten  per  cent,  of  the  civilized  world.  To  Koller 
is  entirely  due  the  credit  of  establishing  its  remarkable 
properties. 


VALUE   OF    ANESTHESIA    AND    ANTISEPSIS.  315 

Synthetic  chemistry  has  advanced  so  far  that  artificial 
substitutes  for  cocaine  are  now  made,  tliough  by  somewhat 
complicated  processes.  Thus  encaine  and  holocaine  are 
now  found  for  sale  in  the  drug-markets  of  both  this  coun- 
try and  Europe.  These  substances  possess  properties  quite 
similar  to  those  of  cocaine,  while  being,  as  a  rule,  less  toxic, 
even  if  a  little  slower  in  their  activities.  In  respect  to  the 
former  this  is  much  to  be  desired.  Cocaine  always  deserves 
to  rank  with  the  "  drugs  that  enslave,"  and  much  harm 
and  misery  have  come  from  its  indiscreet  or  indiscriminate 
popular  use.  It  should  always  be  represented  and  dis- 
pensed as  a  dangerous,  even  poisonous,  drug,  though,  like 
opium,  possessed  of  wonderful  properties. 


CHAPTER  XIII 

THE   HISTORY   OF    ANTISEPSIS. 

Sepeis,  Asepsis,  and  Antisepsis.  The  Germ-theory  of  Disease.  Gay-Liissac's 
Researches.  Schwann.  Tyndall.  Pasteur.  Davaine.  Lord  Lister  and 
his  Epoch-making  Revolution  in  Surgical  Methods.  ^Modifications  of  his 
Earlier  Technique  without  Change  in  Underljing  Principles,  which  Still 
Remain  Unshaken.  Changes  Effected  in  Consequence.  Comparison  of 
Old  and  Modem  Statistics. 

Modern  surgery,  and,  in  no  small  degree,  modem 
treatment  of  all  disease,  have  been  so  completely  modified 
from  previous  methods  by  the  introduction  of  the  so-called 
antiseptic  system  that  it  seems  to  be  only  right  to  devote 
some  time  in  such  a  work  as  this  to  a  resume  of  the 
history  of  the  doctrines  and  experiments  which  have  led 
to  the  perfection,  as  it  would  seem,  of  modern  methods. 

The  adjective  "  septic "  comes  from  the  Greek  word 
"  sepsis,"  which  is  often  transferred  to  the  English,  and 
which  means  "putrefaction,"  or  that  which  is  putrid,  or 
undergoing  decomposition.  From  this  word  are  formed  two 
others, — namely,  "aseptic"  and  "antiseptic," — the  one 
implying  the  exclusion  of  all  causes  of  putrefaction  and 
complete  freedom  from  it,  the  other  referring  to  methods 
employed  to  antidote  the  effect  or  counteract  the  influence 
of  the  agencies  w  hich  produce  sepsis  or  destroy  them  while 
still  within  the  living  body.  By  general  usage  the  term 
"antiseptic"  has  been  construed  as  the  more  comprehen- 
sive; hence,  the  modern  method  is  usually  spoken  of  as 
"antiseptic  surgery,"  and  hence  the  title  above:  "The 
History  of  Antisepsis." 

The  principle  underlying  the  resort  to  antiseptic  methods 
is  summed  up  in  the  expression,  now  so  generally  received, 
— tlie  "germ-theory"  of  disease.  It  refers,  in  general,  to 
the  so-called  zymotic,  or  infectious,  diseases,  whose  mani- 
festations are  protean,  which  are  all  communicable  by  one 
(316) 


FRIGHTFUL   CONDITIONS   PRIOR   TO    ANTISEPSIS.  317 

means  or  another,  but  which  are  not  all  necessarily  conta- 
gious ;  some  of  which,  being  not  at  all  amenable  to  surgical 
treatment, are  regarded  as  "medical"  diseases,  while  others, 
which  occur  mostly  in  connection  with  surgical,  cases,  or 
which  lead  to  conditions  requiring  surgical  relief,  are  usually 
spoken  of  as  "  surgical  "  diseases.  As  excellent  and  only 
too  common  examples  of  these  zymotic  diseases  may  be 
mentioned  tetanus,  erysipelas,  puerperal  fever,  typhoid 
fever,  and  those  varied  conditions  which  are  generally 
grouped  under  the  term  "  blood  poisoning."  Those  which 
most  concern  the  surgeon,  and  those  in  which  most  remark- 
able relief  has  been  obtained  are  erysipelas  and  the  various 
forms  of  blood  poisoning.  These,  in  their  varied  manifes- 
tations, have,  until  recently,  been  literally  the  terror  of 
surgeons,  and  in  military  hospitals,  for  instance,  have  been 
the  cause  of  more  deaths  than  have  ever  resulted  from 
wounds  directly  upon  the  battle-field.  In  civil  hospitals, 
as  well  as  in  general  and  private  practice,  the  mortality 
from  these  diseases  was,  until  twenty-five  years  ago,  simply 
friglitful ;  while  frequently,  and  over  wide  areas  of  territory, 
endemics  and  epidemics  of  puerperal  fever  would  result  in 
the  death  of  almost  every  lying-in  woman.  In  consequence 
of  this  terrible  death-rate  surgeons  were  afraid  to  operate, 
and  certain  classes  of  operations,  especially  those  on  the 
abdomen  and  joints,  were  never  performed,  except  under 
most  exacting  circumstances.  But  few  of  the  present  gen- 
eration can  actually  realize  the  completeness  of  the  changes 
brought  about  by  tlie  adoption  of  the  germ-theory,  and  the 
practical  effect  of  its  use  as  a  working  basis  for  combating 
disease. 

While  no  intelligent  student  at  present  denies  that  the 
infectious  diseases — of  which  the  above  named  are  but  a 
very  few — are  the  result  of  the  introduction  into  the  body, 
from  without,  of  minute  living  organisms,  for  the  most 
part  vegetable, — tlius  constituting  them  in  reality,  as  they 
are  often  csiWed, parasitic  diseases, — but  few  are  so  familiar 


318  THE    HISTORY   OF    MEDICINE. 

with  the  history  of  modern  discovery  as  to  appreciate  the 
basis  upon  which  it  has  been  demonstrated.  The  proof  of 
the  germ  origin  of  disease  is  the  legitimate  outcome  of 
the  discovery  of  the  actual  causes  of  fermentation  and 
putrefaction. 

Aside  from  the  crude  and  often  wild  notions  which  have 
appeared  here  and  there  in  literature  of  previous  centuries, 
about  the  first  accurate  investigations  bearing  upon  this 
subject  were  with  reference  to  the  cause  of  alcoholic  fer- 
mentation. About  the  beginning  of  this  century  Appert 
published  a  monograph  upon  the  Art  of  Preserving  Animal 
and  Vegetable  Substances,  which  consisted  in  placing  them 
in  closely  corked  or  stoppered  bottles,  and  exposing  these 
to  the  temperature  of  boiling  water.  Gay-Lussac,  the 
celebrated  cliemist,  noticed  that  so  soon  as  these  vessels 
wigre  opened,  particularly  if  much  exposed  to  air,  their 
contents  began  to  at  once  ferment  or  putrefy.  This  led  to 
investigations  into  the  production  of  alcohol,  and  the  anti- 
septic effect  of  pure  oxygen-gas;  from  which  he  concluded 
that  oxygen  is  necessary  at  the  commencement  of  the 
process,  but  not  throughout  its  continuance.  Some  thirty 
years  later,  Schwann,  by  the  use  of  the  microscope,  then 
reasonably  developed,  discovered  in  fermenting  substances 
numerous  very  minute  globular  bodies,  which  had  the 
power  of  reproduction,  and  which  were  present  in  juices 
or  fluids  undergoing  alcoholic  fermentation,  but  not  in 
others,  and  which  he  concluded  to  be  the  exciting  cause. 
Schwann  also  discovered  that  if,  in  vessels  sealed  by  Appert's 
method,  he  allowed  air  which  had  been  previously  heated 
to  come  in  contact  with  the  fluids,  no  change  resulted ; 
from  which  it  was  evident  that  it  was  something  other 
than  the  gaseous  elements  of  tlie  air  which  provoked  fer- 
mentation. Schwann's  investigations  were  corroborated,  in 
1843,  by  Helmholtz. 

Schwann's  results  were  contested  by  Liebig.  one  of  the 
most  eminent  chemists  of  his  time,  who  proposed  a  very 


RESEARCHES   ON    STERILIZATION.  319 

different  theory,  ascribing  putrefaction  to  the  absence  of 
oxygen  and  to  the  upsetting  of  molecular  arrangements. 
He  believed  that  non-nitrogenous  substances  did  not  spon- 
taneously undergo  putrefaction  when  pine,  but  tliey  must 
be  brought  into  contact  with  some  substance  already  un- 
dergoing change,  which  latter  was  called  a  ferment^  and 
which  converted  the  oxygen  of  the  air  into  carbonic  acid. 
According  to  him,  the  ferment  was  some  material  under- 
going decomposition. 

The  next  researches  on  this  subject  were  those  of 
Schroeder  and  Dusch,  in  1854,  who  studied  the  question 
whether  filtration  of  air  would  prevent  the  fermentation 
of  boiled  fluids  to  which  such  filtered  air  might  have 
access.  The  material  used  for  filtration  was  cotton-wool ; 
and  they  showed  that  air  filtered  through  it  was  de- 
prived of  the  agencies  which  produce  fermentation.  Then 
came  Pasteur,  who  repeated  the  experiments  of  his  pre- 
decessors and  elaborated  and  confirmed  them.  He  also 
found  that  it  was  not  necessary  to  filter  the  air  of  its  con- 
tained particles,  but  that  if  it  were  simply  left  undisturbed 
until  these  had  settled  by  gravity,  it  might  then  be  brought 
in  contact  with  putrescible  substances  without  causing  any 
putrefaction. 

In  1870,  in  a  lecture  upon  haze  and  dust,  Tyndall 
demonstrated  beautifully  and  in  public  the  presence  of 
countless  particles  in  the  air,  as  well  as  that  these  were  the 
agencies  operating  to  produce  undesirable  changes  in  or- 
ganic substances.  Both  Pasteur  and  Tyndall,  as  well  as 
others,  showed,  as  did  also  Lister,  that  heat  as  well  as 
filtration  was  sufficient  to  render  these  particles  innocuous. 
As  tlie  result  of  these  and  numerous  other  experiments, 
by  various  observers,  which  tliere  is  no  time  here  to  re- 
count, it  was  gradually  and  irrefutably  established  that  the 
gases  of  the  air,  -per  se,  are  powerless  to  cause  fermentation 
or  putrefaction  in  boiled  fluids  or  tissues,  or  in  material 
germ-free  when  exposed.     It  was  sufficient,  in  order  to  so 


320  THE   HISTORY   OF   MEDICINE. 

purify  the  air,  to  either  previously  heat  it  or  filter  it 
through  cotton-wool  or  through  fluids  inimical  to  germ- 
life,  while  the  boiling  of  organic  material  or  its  subjection 
to  the  boiling  heat  of  water  was  sufficient  to  destroy  all 
germ-activity  in  it  at  the  time,  or,  as  we  say  now,  to  ster- 
ihze  it. 

In  this  way,  and  even  before  any  minute  and  systematic 
study  of  bacteria, — i.e.,  before  the  inauguration  of  bacteri- 
ology as  a  separate  department  of  scientific  study, — it  was 
practically  established  that  the  agencies  which  produce 
putrefactive  changes  or  fermentation  were  minute  particles 
which  were  ever  present  in  almost  every  substance,  and 
that  by  heat  or  something  corresponding  to  filtration  it  was 
possible  to  remove  them  or  destroy  their  activity. 

So  "much  had  been  established  without  reference  to  the 
etiology  of  disease.  In  order  now  to  study  the  germ- theory 
of  disease  as  applied  to  man  we  must  go  back  a  little, 
neglecting  the  vagaries  or  the  pure  conjectures  of  the 
ancients,  to  the  era  of  pure  philosophic  speculation, — per- 
haps to  the  days  of  Needham  and  Buftbn, — to  the  middle 
of  the  previous  century,  when  scientists  and  naturalists 
began  to  discuss  the  so-called  spontaneous  generation  of 
life ;  for  it  is  well  known  that  fluids,  like  milk  and  others, 
abound  with  life  after  a  few  days  of  exposure ;  and  it  was 
supposed  that  the  living  organisms  it  contained  had  a 
spontaneous  origin.  This  question  of  the  spontaneous 
beginning  of  minute  living  forms  was  agitated  for  a  cent- 
ury, or  practically  until  Tyndall  and  Pasteur  gave  it  its 
death-blow  by  their  accurate  and  convincing  demonstra- 
tions. There  was  no  lack  of  experimentation,  but  there 
was  lack  of  exact  knowledge  and  of  accurate  deduction 
from  facts  observed.  The  bacteria — which  at  that  time 
were  usually  spoken  of  as  "  monads "  and  "  vibriones," 
because  of  their  spontaneous  motion — were  found  under 
varying  circumstances,  which,  not  being  scientifically  in- 
quired into,  led  thinking  men  into  a  most  perplexing  con- 


SPONTANEOUS   GENERATION    OF    LIFE    DISPROVEN.        321 

ditiou  of  mind.  The  two  most  ardent  recent  advocates 
of  spontaneous  generation  were  Bastian,  of  England,  wlio 
wrote  an  elaborate  treatise  upon  the  subject,  and  Jeffries 
Wyman,  of  Cambridge,  Mass.,  who  gave  it  the  benefit  of 
all  his  influence.  But,  under  the  influence  of  blows  dealt 
from  the  side  of  the  physical  laboratory  by  Tyndall,  and 
from  that  of  the  biologists  by  Pasteur,  the  theory  was 
weakened  and  effectually  killed,  so  that  to-day  no  one 
thinks  of  such  a  thing.  On  the  contrary,  life  seems  to  be 
inevitably  the  gift  of  a  preceding  organism ;  and  while  the 
real  origin  of  life  is  as  unknown  to-day  as  ever,  there  is  not 
a  single  fact  in  the  possession  of  scientists  now  justifying 
the  view  that  life  can  have  a  spontaneous  origin.  More- 
over, the  researches  of  Pasteur  and  others  into  alcoliolic 
fermentation  and  the  role  played  by  the  minute  yeast-plant, 
and  the  early  researches  of  Pasteur,  Davaine,  and  Koch 
into  the  role  of  micro-organisms  in  producing  disease  in 
animals,  and  the  scientific  and  elaborate  study  of  bacteria 
and  vegetable  molds,  inaugurated  by  Colin  and  continued 
by  many  others,  have  as  their  legitimate  outcome  the 
creation  of  bacteriology  as  a  science,  and  the  establishment 
of  the  fact  that  the  real  condition  in  the  so-called  infectious 
diseases  is  one  of  fermentative  or  putrefactive  alterations  in 
the  fluids  and  tissues  of  the  living  body,  corresponding  in 
minutiae  to  the  changes  produced  in  saccharine  fluids  by 
the  yeast-plant,  or  in  decomposing  animal  or  vegetable 
matter  by  the  many  known  bacteria  which  are  capable  of 
producing  such  changes.  To  put  it  in  another  way,  dis- 
ease is  simply  an  expression  of  the  fact  that  these  minute 
organisms,  which  are  visible  only  under  high  powers  of  the 
microscope  and  which  reproduce  their  kind  with  astonish- 
ing rapidity,  gaining  access  to  the  surface  or  interior  of  the 
body,  begin  there  to  thrive  and  multiply,  taking  up  from 
the  living  animal  material  for  their  own  nourishment,  thus 
robbing  their  host  of  that  upon  which  his  tissues  must  live, 
while  at  the  same  time,  as  the  result  of  their  activity,  they 


322  THE    HISTORY    OF    MEDICINE. 

produce  various  substances  which,  so  far  as  they  are  con- 
cerned, are  excretory  in  nature,  and  many  of  which  are 
extremely  poisonous  to  the  animal  organism  which  harbors 
them.  Such  a  disease  as  puerperal  fever,  for  instance,  is 
simply  an  expression  of  the  fact  that  within  the  living 
human  body  there  is  going  on  active  putrefactive  change,  by 
which  the  internal  cells  are  being  destroyed,  this  destruction 
being  progressive  and  often  far-reaching;  and  that,  as  the 
result  of  their  presence  in  the  still  living  body,  the  noxious 
or  toxic  excretory  materials  of  which  they  get  rid  are  ab- 
sorbed, in  consequence  of  wliich  such  varying  symptoms  as 
nausea,  fever,  purging,  vomiting,  delirium,  and  many  otlier 
symptoms  are  produced,  the  objective  evidence  of  their  local 
activity  being  the  actual  destruction  of  tissues,  as  is  seen  in 
cases  of  abscess,  phlegmonous  erysipelas,  etc.  The  con- 
dition known  everywhere  as  gangrene,  when  moist  and 
offensive,  is  nothing  but  the  putrefaction  of  tissues  en  masse 
which  are  not  yet  detached  or  separated  from  the  living- 
body  of  which  they  but  recently  formed  a  living  part. 

Experiments  with  organic  material  outside  the  body 
have  amply  demonstrated  that  such  putrefactive  processes 
can  be  checked  by  certain  precautions, — such  as  filtration 
of  air,  heat,  etc.  It  remained  for  the  genius  of  Lister  to 
show  how  similar  processes  of  putrefaction  and  exclusion 
of  germs  could  be  made  serviceable  for  the  prevention  of 
disease  in  the  human  race.  To  Lister,  then,  is  due  the 
credit  of  having  originated  the  antiseptic  system  and 
brought  about  a  condition  long  yearned  for  by  surgeons 
tliroughout  the  world,  but  never  previously  attained.  What 
a  revolution  he  wrought  by  his  masterly  researches  can  be 
appreciated  only  when  one  compares  tlie  impunity  with 
which  surgeons  now  perform  operations  which,  in  the  pre- 
antiseptic  era  were  regarded  as  absolutely  unjustifiable, — 
a  conclusion  amply  warranted  by  the  statistics  of  that  era. 
Great  as  is  the  credit  due  to  Lister,  it  is  equally  desirable 
to  state  that  his  work  was,  for  the  most  part,  based  upon 


LISTER  S    STUDIES    AND    METHODS. 


323 


the  researches  of  Tyndall,  Pasteur,  and  Koch,  which  had 
established  the  germ  nature  of  the  terrible  infectious  dis- 
eases and  the  germicidal  effect  of  filtration,  of  heat,  and  of 
certain  other  substances  and  methods  which  permitted  of 
the  development  of  his  own  system. 

The  antiseptic  method,  as  it  has  since  been  known,  was 
naturally  at  first  crude,  although  its  scientific  basis  has 
never  been  shaken ;  and  that  it  has  been  since,  in  large 


Fig.  r>t)  — Lokd  [.istkr,  M.D.,  D.C.L.,  LL.D.,  P.R.S. 

(From  a  photograph.) 

measure,  modified,  and  that  surgeons  now  resort  to  little, 
if  any,  of  the  paraphernalia  which  first  made  it  such  a 
formal  proceeding,  in  no  regard  shake  the  scientific  nature 
of  its  foundation,  but  rather  have  tended  ever  to  corroborate 
it  and  establish  it  more  and  more  firmly.  Lister  began  with 
the  supposition  that  the  air  contains  the  germs  which  are 
most  active  and  pernicious  in  producing  disease.  It  lias 
been  since  learned  tliat  air-contact  is,  perhaps,  least  of  all 


324  THE    HISTORY   OF   MEDICINE. 

to  be  dreaded.  We,  liowever,  recognize  the  germs  as 
always  the  efficient  agents,  though  we  have  since  learned 
that  other  sources  of  contamination  are  mucli  more  to  be 
dreaded  than  air.  It  had  been  the  custom,  up  to  Lister's 
time,  to  observe  usually  the  ordinary  forms  of  cleanliness, 
but,  not  appreciating  the  multitude  of  germs  which  lurk 
in  and  about  the  skin,  it  had  not  been  customary  to  scour 
and  prepare  it  as  we  have  learned  to  do  since  Lister's  day. 
The  ligatures  and  instruments  which  were  used  and  the 
dressings  which  were  applied,  as  well  as  the  sponges  used 
during  the  operation,  usually  went  through  the  ordinary 
forms  of  cleansing ;  and  yet  Lister's  investigations  showed 
the  utter  inadequacy  of  such  preparation.  His  most  im- 
portant object-lesson,  however,  was  that  everything  that 
came  in  contact  with  fresh  or  bleeding  tissues  might  carry 
infectious  material  (i.e.,  germs),  unless  it  had  itself  been 
thoroughly  freed  from  their  presence.  Accordingly,  the 
system  taught  the  accurate  preparation  of  everything, — 
from  the  skin  of  the  patient,  which  was  to  be  carefully 
cleansed  and  shaven,  to  the  hands  of  the  operator,  which 
were  to  be  scrupulously  scrubbed,  as  well  as  those  of  every 
assistant  who  might  handle  or  touch  any  of  the  instruments 
or  dressing  materials.  It  included,  also,  the  careful  prepa- 
ration of  sponges,  sutures,  and  ligature  materials,  all  of 
which  were  kept  protected  from  air-contact  and  in  anti- 
septic solutions  until  the  jnoment  of  their  use.  The  dress- 
ing materials  were  impregnated  with  substances  like  carbolic 
acid,  which  had  b^en  proven  to  be  germicidal ;  and  imper- 
meable material,  like  oiled  silk,  was  used  to  cover  the 
surgical  dressing,  in  order  that  fluids  which  might  leak 
through  should  not  come  in  contact  with  the  air,  which 
might  permit  of  their  putrefaction,  while,  at  the  same 
time,  air  from  without  could  have  no  access  to  the  deeper 
parts  thus  protected. 

Tlie  original  method  of  Lister  was  very  elaborate,  and 
included  also  the  dissemination  througliout  the  air  of  the 


SIMPLIFICATION    OF   ANTISEPSIS.  325 

opeiatiiig-room  of  a  vapor  of  carbolic  acid,  which  was  dis- 
agreeable, sometimes  almost  fatal,  to  operators  and  by- 
standers alike, — its  use  being  based  upon  the  notion  that 
the  air  was  the  substance  most  to  be  dreaded.  The  instru- 
ments were  placed  in  strong  antiseptic  solutions,  usually 
carbolic,  which  were  pungent  and  irritating  to  the  hands 
of  all  that  came  in  contact  with  them.  So  thoroughly  and 
ubiquitously  were  antiseptic  materials  employed  that  it  was 
soon  learned  that  they  were  of  themselves  rather  injurious 
to  the  best  interests  of  the  patients  upon  whom  they  were 
employed.  Their  use,  of  course,  was  contingent  upon  the 
notion,  then  everywhere  prevalent,  that  powerful  sub- 
stances must  be  used  in  order  to  counteract  the  activity  of 
the  much-dreaded  germs. 

In  the  course  of  time,  however,  it  was  learned  that  the 
air  was  not  so  much  to  be  dreaded  as  had  been  supposed, 
and  that  even  if  it  came  in  contact  with  raw  tissues  infec- 
tion did  not  certainly  follow.  It  was  found  also  that  the 
antiseptic  solutions  which  had  been  so  freely  used  for  irri- 
gating or  drenching  the  parts  during  an  operation  were  by 
no  means  essential,  and  that  tissues  often  healed  better 
which  had  not  been  subjected  to  so  much  irritation.  It 
was  learned  further  that  it  was  not  necessary  to  impregnate 
dressings  with  these  same  solutions,  providing,  in  the  first 
place,  they  were  carefully  sterilized  by  the  application  of 
heat,  which  in  time  came  to  be  used  for  the  purpose  of 
sterilizing  everything  not  injuriously  affected  by  it.  In 
consequence,  then,  all  dressing  material,  silk  ligatures,  in- 
struments, nail-brushes,  etc.,  were  subjected  to  live  steam 
or  to  boiling  water  for  twenty  minutes  or  more,  which  was 
demonstrated  to  be  completely  effective  in  the  destruc- 
tion of  all  organic  or  bacterial  life.  This,  of  itself,  was  a 
very  great  simplification  of  the  antiseptic  method.  It  was 
also  demonstrated  that  the  vital  fluids  of  the  animal  body 
liad  of  themselves  great  germicidal  power,  and  that  the 
strong  antiseptic  fluids  previously  used  tended  rather  to 


326  THE    HISTORY    OF   MEDICINE. 

impair  this  power  than  to  enhance  it.  Accordingly,  fluids 
for  irrigation  came  to  be  used  only  when  there  was  some 
noxious  material  to  be  washed  away.  It  was  found  that 
fresh  wounds  healed  most  kindly  when  least  irritated  by 
applications  of  any  kind,  providing  only  that  nothing  came 
in  contact  with  them  which  could  infect  them.  And,  in 
this  way,  as  well  as  by  resort  to  simpler  rather  than  com- 
plicated procedures,  there  was  gradually  substituted  for  the 
so-called  cm^iseptic  method  that  which  is  now  everywhere 
recognized,  and  always  practiced,  when  possible, — i.e.,  the 
aseptic  method.  This  simply  means  that  it  is  very  much 
better  to  exclude  germs  than  to  permit  of  their  access  and 
then  try  to  kill  them  after  they  have  lodged.  The  aseptic 
method  is,  therefore,  now  in  vogue,  and  among  the  best 
operators  always  the  so-called  dry  method  of  operating, 
which  means  that,  so  far  as  possible,  nothing  not  absolutely 
needed  at  the  moment  should  come  in  contact  with  the 
field  of  operation.  This  has  been,  in  many  respects,  a 
great  advance  over  the  older  antiseptic  method,  though 
based  upon  absolutely  the  same  recognition  of  causes, 
being  only  an  improvement  in  technique. 

The  benefits  of  Lister's  studies,  and  of  that  which  has 
grown  out  of  them,  are  simply  incalculable.  The  surgical 
infections  which,  thirty  years  ago,  were  the  dread  of  all 
operating  surgeons,  have  practically  disappeared  from  civil 
and  military  hospitals.  1  esteem  myself  fortunate  in  this, — 
that  I  have  been  a  living  witness  of  the  benefit  of  change 
from  the  old  to  the  new,  since  when  I  began  my  work,  in 
1816  (over  twenty  years  ago),  as  a  hospital  interne^  in  one 
of  the  largest  hospitals  in  this  country,  it  happened  that 
during  my  first  winter's  experience, — with  but  one  or  two 
exceptions, — every  patient  operated  upon  in  that  hospital, 
and  that  by  men  who  were  esteemed  the  peers  of  any  one 
in  their  day,  died  of  blood  poisoning,  while  I  myself  nearly 
perished  from  the  same  disease.  Tliis  was  in  an  absolutely 
new  building,  where    expenditure   had  been   lavish  ;    one 


BENEFITS   OF    LISTER'S   WORK.  327 

whose  walls  were  not  reeking  with  germs,  as  is  the  case 
yet  in  many  of  the  old  and  well-established  histitntions. 
With  the  introduction  of  the  antiseptic  method,  during 
the  two  years  following,  this  frightful  mortality  was  reduced 
to  the  average  of  the  day,  and  in  the  same  institution  to-day 
is  done  as  good  work  as  that  seen  anywhere.  The  same 
was  true  without  exception  in  the  great  hospitals  of  the 
Old  World;  and  in  Paris,  where,  thirty  years  ago,  famous 
surgeons  would  go  from  one  end  of  the  building  to  the 
other,  handling  one  patient  after  another  without  ever 
washing  their  hands,  and  where  erysipelas  and  contagion 
of  various  kinds  were  thoroughly  distributed,  as  it  were, 
impartially,  now  the  successors  of  these  veiy  same  men, 
employing  modern  methods,  get  results  which  challenge 
comparison. 

The  world  has  seen  few  extensive  wars  since  the  in- 
troduction of  the  antiseptic  system ;  but,  in  such  as  have 
occurred,  its  incalculable  value  in  military  hospitals  has 
been  amply  demonstrated.  The  modern  soldier  is  now 
taught  how  to  make  a  prompt  occlusive  and  antiseptic 
dressing  of  the  wound  which  he  may  receive  upon  the 
battle-field,  which,  from  the  moment  of  its  attention,  con- 
tinues to  be  treated  according  to  the  same  enlightened 
method  after  he  reaches  the  field-hospital,  or  when  sent  to 
the  rear ;  so  that  men  now  receive  extensive  injuries  to 
joints  and  to  viscera,  which  previously  were  either  promptly 
fatal,  or  fatal  within  a  few  days  from  erysipelas  and  hos- 
pital gangrene,  from  which  they  recover  with  useful — often 
witli  nearly  perfect — limb  or  function  of  part  restored. 

The  military  hospital  of  to-day  is,  therefore,  robbed  of 
the  terrors  which  used  to  make  it  almost  a  charnel-house  ; 
hospital  gangrene,  the  special  dread  of  active  army-surgeons 
in  time  past,  has  almost  disappeared  from  the  category  of 
known  diseases,  and  one  of  the  greatest  dangers  menacing 
the  modern  soldier  has  been  removed  from  modern  civilized 
life.     The  method  has  met  with  universal  adoption  among 


328  THE   HISTORY    OF    MEDICINE. 

all  civilized  races  and  peoples,  and  all  this  tlirough  the 
energy  and  talent  of  the  originator,  now  Sir  Joseph  Lister. 

With  tlie  recognition  of  the  germ  nature  of  so  many 
acute  diseases  has  come  also  systematic  study  of  the  use  of 
antiseptics  internally ;  and,  while  no  such  exceeding  satis- 
faction has  resulted  from  labors  in  this  direction,  we  have, 
nevertheless,  learned  that  most  of  the  infectious  diseases  of 
the  alimentary  canal — for  example,  cholera,  typhoid,  etc. — 
are  well  attacked  by  means  of  antiseptics  administered 
internally ;  that  many  of  the  conditions  that  depress  and 
annoy  are  due  to  the  presence  of  germs  in  the  alimentary 
canal  and  the  urinary  system,  and  are  best  combated  by 
means  which  shall  remove  these  agencies,  if  not  destroy 
them.  It  has  been  learned,  also,  that  many  forms  of  skin 
disease  are  parasitic,  and  that  these  are  only  successfully 
treated  by  the  employment  of  antiseptics  externally. 

And  so  the  recognition  of  the  germ  nature  of  infectious 
diseases  and  the  germicidal  properties  of  certain  substances, 
now  spoken  of  as  antiseptics,  have  kept  pace,  the  one  with 
tlie  other ;  and  in  consequence  the  world  has  reached  a 
period  in  its  medical  history  never  even  dreamed  of  by  our 
forefathers,  when  the  infectious  diseases  have  been  shown 
to  be  practically  preventable  and,  to  a  large  extent,  curable 
by  the  employment  of  drugs  directed  especially  against 
their  exciting:  cause.  What  the  years  to  come  mav  have 
in  the  way  of  further  discovery  in  this  direction,  we  may 
not  foresee.  So  far  as  one  can  at  present  see  ahead,  the 
next  advances  must  be  in  the  direction  either  of  means 
which  shall  fortify  the  human  organism  against  the  inroads 
of  bacteria,  or  disease-germs,  or  else  in  the  discovery  of 
substances,  such  as  we  do  not  yet  know,  which  shall  be  at 
the  same  time  poisonous  to  the  germs  and  innocuous  to 
the  patient,  to  whom  they  may  be  administered  in  doses 
sufficient  for  their  purpose.  Any  material  possessing  these 
properties  would  be  an  ideal  antiseptic  for  internal  pur- 
poses.    At  present  we  only  approach  our  ideal,  but  are 


NEED    OF    A    PERFECT   INTERNAL    ANTISEPTIC.  329 

very  far  from  its  active  realization.  In  no  way  would 
mankind  be  more  greatly  benefited  than  by  the  prose- 
cution of  studies  which  may  lead  to  satisfactory  results  in 
either  of  these  directions. 

The  writer  makes  no  apology  here  for  having  intro- 
duced two  distinct  chapters, — one  upon  the  history  of  anti- 
septic surgery,  tlie  other  upon  the  history  of  anaesthesia. 
First  of  all,  they  are  the  two  grandest  medical  discoveries 
of  all  time  ;  and,  secondly,  they  are  of  Anglo-Saxon  origin, 
— the  one  British,  the  other  American.  To  the  intro- 
duction of  anaesthetics  and  antiseptics  is  due  a  complete 
revolution  of  earlier  methods,  complete  reversal  of  mortu- 
ary statistics,  and  the  complete  relief  of  pain  during  sur- 
gical operations ;  in  other  words,  to  these  two  discoveries 
the  human  race  owes  more  of  the  prolongation  of  life  and 
relief  of  suffering  than  can  ever  be  estimated  or  formulated 
in  words.  What  an  everlasting  disgrace  it  is  that,  while 
to  the  great  murderers  of  mankind,  men  like  Napoleon 
in  modern  times  and  his  counterparts  in  all  times,  the 
world  ever  does  honor,  erects  imposing  monuments  and 
writes  volumes  of  encomiums  and  flattering  histories,  the 
men  to  whom  the  world  is  so  vastly  more  indebted  for  all 
that  pertains  to  life  and  comfort  are  scarcely  ever  men- 
tioned save  in  medical  history,  while  the  world  at  large  is 
even  ignorant  of  their  names.  For  this  reason,  if  for  none 
other,  these  chapters  find  an  appropriate  place  in  a  work 
of  this  character. 


CHAPTER  XIV. 

AN    EPITOME   OF   THE    HISTORY    OF    DENTISTRY. 

Rude  Deutistry  of  Prehistoric  Times.  Early  Instruments  for  Extraction  ]Made 
of  Lead.  Dentistrj-  on  the  Same  Low  Plane  as  Metlicine  during  the  First 
Half  of  the  Christian  Era.  Dentistry  Taught  at  the  School  of  Salernum. 
Progress  of  the  Art  on  the  Continent.  Prosthesis  and  Substitutes  for 
Human  Teeth.  Introduction  of  Porcelain  for  Artificial  Teeth  ;  of  Metal 
and  of  Vulcanized  Rubber  for  Plates  ;  of  Plaster  for  Impressions.  From 
being  a  Trade,  Dentistry  is  now  a  Profession,  in  which  Americans  lead  the 
World.     Statistics. 

The  following  is  a  synopsis  of  an  address  delivered  at 
the  opening  of  the  session  of  the  Dental  Department  of 
the  University  of  Buffalo,  in  October,  1895.  It  is  appended 
here  because  it  is  certainly  apropos  of  the  topics  herein 
considered,  the  colloquial  form  being  retained. 

Called  upon  at  short  notice  to  welcome  you  here,  and 
to  offer  remarks  of  general  professional  interest,  it  occurs 
to  me  to  be  retrospective  for  awhile  and  to  consider  the 
steps  by  which  that  which  was  once  an  exceedingly  crude 
art  has  been  developed  until  now  it  is  an  exact  science. 
In  other  words,  I  would  invite  your  attention,  for  a  time, 
to  the  history  of  dentistry.  At  a  time  even  before  our 
combined  art  and  science  had  a  definite  history  we  find 
that  gold  was  used  among  the  Egyptians  for  the  purpose 
both  of  filling  teeth  and  of  supporting  and  directing  them. 
In  the  bodies  of  many  Egyptian  mummies,  especially  of 
the  higher  class,  there  have  been  found  teeth  filled  with 
gold  or  with  wood  which  was  covered  with  gold.  It  is 
known,  also,  that  the  Hindoos  and  Egyptians  inserted 
artificial  teeth  and  that  some  of  these  were  made  of  wood, 
often  covered  Avith  s^old,  and  held  in  place  by  gold  or  silver 
bands  and  wires.  Herodotus,  who  traveled  so  extensively 
ill  Egypt  and  wrote  most  entertainingly  of  his  travels,  has 
noted  the  division  of  medicine  among  the  Egyptians  into 
special  branches  and  the  existence  of  pliysicians,  each  of 
(330) 


RUDE    ANCIENT    AND    MEDIEVAL    DENTISTRY.  331 

whom  applied  himself  to  one  disease  and  not  to  more. 
"  Some,"  said  he,  "  are  for  the  eyes,  others  for  the  head, 
others  for  the  teetli^  and  others  for  internal  disorders." 

It  is  known,  also,  that  about  300  B.C.  Erasistratus  de- 
posited in  the  temple  of  the  Delphian  Apollo  an  odonto- 
gogue,  or  tooth-forceps,  made  of  had,  intimating  thereby 
that  only  those  teeth  should  be  drawn  which  were  loose 
enough  to  be  extracted  with  such  an  instrument. 

Celsus,  who  was  a  contemporary  of  Christ  and  of 
Caesar,  was  the  first  to  recommend  the  use  of  a  file  within 
the  mouth  for  the  purpose  of  removing  irritating  edges 
and  points  of  teeth.  He  also  recommended  bursting 
hollow  teeth  by  putting  into  them  pepper-corns,  which 
should  absorb  moisture,  swell,  and  tlius  break  the  teeth  in 
pieces.  He  also  recommended  to  take  particular  pains  to 
try  to  shake  or  manipulate  teeth  loose  before  extracting 
them. 

Galen,  about  150  a.d,,  taught  tliat  teeth  were  true 
bones  and  that  the  canine  teeth  should  be  called  "  eye  " 
teeth,  because  they  were  supplied  by  a  branch  of  the  optic 
nerve.  Aetius,  300  a.d.,  apparently  discovered  the  foram- 
ma  at  the  roots  of  the  teeth  through  which  the  nerves 
enter. 

In  Rome  false  teeth  and  sets  of  teeth  constructed  of 
ivory  and  fastened  with  gold  wire  existed  as  early  as  the 
Laws  of  the  XH  Tables,  and  before  the  days  of  Roman 
civilization  it  is  known  that  the  Etruscans  were  skilled  in 
manipulation  of  gold  within  the  mouth,  while  your  dean 
has  described  and  has,  I  believe,  in  his  possession  beautiful 
examples  of  Etruscan  work  of  this  kind. 

Anion":  the  Arabs,  after  the  Arabian  domination  of  the 
then  civilized  world,  attention  Avas  paid  to  the  teeth, 
although  this  was  considered  a  very  inferior  part  of  the 
physician's  work.  Among  these  Arabians  much  later,  and 
in  spite  of  their  study  of  Greek  writers  and  their  transla- 
tions from  the  Greek,  there  may  still  be  met  such  passages 


332  THE   HISTORY   OF   MEDICINE. 

as  this  from  Garriopontus,  1045  a.d.  :  "On  the  island  of 
Delphi  a  painful  molar  tooth,  which  was  extracted  by  an 
inexperienced  physician,  occasioned  the  death  of  a  philoso- 
pher, for  the  marrow  of  the  tooth,  which  originates  from 
the  brain,  ran  down  into  the  lungs  and  killed  that  philoso- 
pher." For  all  that  I  know,  this  is  the  first  record  of  a 
death  after  extraction  of  a  tooth.  Albucassis,  1100  a.d., 
gave  directions  for  replacing  lost  teeth  by  natural  or  ivory 
substitutes.  For  centuries  extraction  of  teeth  had  been 
and  was  considered  a  critical  and  dangerous  operation, 
although  itinerant  quacks  drew  them  without  hesitation. 

The  Roman  poets  and  satirists  made  many  allusions,  in 
their  day,  to  the  teeth  and  to  operations  performed  upon 
them. 

During  the  Middle  Ages  the  most  celebrated  medical 
school  that  the  world  ever  saw  was  founded  at  Salernum, 
and  was  for  several  centuries  the  headquarters  to  which 
resorted  men  who  desired  to  study  medicine  and  patients 
from  all  parts  of  the  Avorld  who  desired  to  be  cured  of 
various  diseases.  It  was  a  favorite  stopping-place  for  cru- 
saders on  their  way  to  and  from  the  Orient,  and  history 
relates  many  interesting  episodes  pertaining  to  such  visits. 
Under  the  influence  of  this  school  dentistry  was  more  or 
less  cultivated  by  those  who  practiced  surgery.  Bruno,  of 
I^angoburo  (about  1250),  mentions  various  operations  upon 
the  teeth  and  the  antrum,  although  that  was  nearly  four 
hundred  years  before  Highmore  carefully  described  this 
cavity.  Johannes  Arculanus  (Giovanni  d'Arcoli),  in 
the  fifteenth  century,  filled  teeth  with  gold.  I  must 
digress  for  a  moment  to  speak  of  another  suggestion  of 
Arculanus's.  You  know  that  quite  recently  the  use  of 
the  magnet  has  once  more  come  into  vogue  among  oculists 
for  the  removal  of  foreign  particles  of  iron  or  steel  from 
the  anterior  chamber  or  the  globe  of  the  eye.  It  was 
Arculanus  who,  some  Ave  hundred  years  ago,  suggested 
extraction  of  iron  splinters  from  the  eye  by  means  of  the 


INTRODUCTION    OF   PORCELAIN    TEETH.  333 

attraction  of  amber  electrified  hy  friction.  (For  School  of 
Salernura  see  page  72.) 

During  the  sixteenth  and  seventeenth  centuries  the 
French  surgeons,  especially  Dion  is  and  Verduc,  made 
many  practical  contributions  to  dentistry.  In  1728  Fau- 
chard  wrote  in  Paris  the  first  complete  work  on  dentistry, 
— Le  Ghirurgien  Dentiste,  ou  Traite  des  Dents.  xA-Uzebi, 
of  Lyons,  wrote  another.  Le  Cluse  first  mentioned  the 
English  turnkey  for  extraction.  Jourdain  introduced  a 
number  of  new  and  appropriate  instruments  and  new 
forms  of  artificial  teeth.  Bourdet,  dentist  to  the  king, 
made  artificial  palates.  Porcelain  teeth  were  first  intro- 
duced in  France  in  1774. 

Among  the  Germans  cosmetic  dentistry,  though  still 
the  favorite  field  of  charlatans,  was  greatly  cultivated. 
Serre  wrote  a  treatise  on  Toothache  in  the  Fair  Sex  During 
Pregnancy.,  but  the  first  public  dental  clinic  in  Germany 
was  not  established  until  1855,  by  Professor  Albrecht,  and 
in  Vienna.  It  has  been  in  Vienna,  among  the  Germans, 
that  dentistry  has  been  in  time  past  most  honored,  and 
was  taught  when  it  was  scarcely  recognized  in  the  other 
German  universities.  Private  dental  institutions  were  also 
first  established  in  Vienna. 

Of  all  the  tooth-extracting  instruments,  the  dental  for- 
ceps in  crude  form  is  the  earliest,  the  first  on  record,  per- 
haps, being  that  deposited  by  Erasistratus  in  the  Delphian 
temple,  as  already  mentioned.  For  hundreds  of  years 
these  instruments  scarcely  changed  in  shape.  It  was  Ga- 
rengeot  who  invented  the  hey,  early  during  the  last  cent- 
ury. Before  that,  and  for  awhile,  dentists  who  had 
abandoned  the  forceps  used  an  instrument  known  as 
the  pelican, — said  to  much  resemble  the  skid  used  by 
lumbermen. 

Before  artificial  (porcelain)  teeth  came  into  use  the  fol- 
lowing substitutes  Avere  employed,  their  estimated  value 
being  in  accordance  with  the  order  in  which  I  name  them: 


334  THE    HISTORY   OF    MEDICINE. 

lliiraan  teetli,  animal  teetli,  hippopotamus-  tusk  and  teeth, 
elephant-ivoiy,  and  bone. 

Human  Teeth. — Transphmtation  of  teeth  was  at  one 
time  very  common.  After  being  inserted,  they  were  held 
in  place  by  pivots  and  ligatures,  springs,  and  upon  bases. 
The  pivot  method  also  included  the  use  of  screws.  Lig- 
atures for  fastening  teeth  were  made  of  silk-worm  gut, — 
which,  now  so  common  in  surgery,  was  used  for  this  pur- 
pose, peiha])s,  two  hundred  years  ago, — of  gold  wire,  etc. 
The  method  by  ligatures  is  the  earliest  of  all.  Human 
teeth  have  always  been  more  or  less  expensive  if  fresh,  few 
people  being  willing  to  part  with  sound  teeth  except  for  a 
money  consideration.  In  1784  a  Philadelphia  dentist 
offered,  in  an  advertisement,  two  guineas  each  for  sound 
front  teeth. 

Animal  Teeth. — These  were  largely  used,  being  held  in 
place  the  same  way  as  above,  the  principal  objection  being 
that  it  was  difficult,  often  impossible,  to  match  human  with 
animal  teeth.  It  was  found,  also,  that  the  latter  decayed 
very  much  more  easily. 

Hippopotamus-ivory. — This  was  at  one  time  very  ex- 
tensively used.  It  was  carved  into  the  shape  of  the  miss- 
ing teeth,  and  was  held  upon  a  base ;  or  it  was  carved  into 
shape  as  a  base  upon  which  to  rest  human  teeth.  Most 
often  it  was  used  as  a  base  for  pivoting.  Not  infrequently 
a  block  was  carved  out  which  represented  gum,  teeth,  and 
all,  and  partial  dentures  of  this  complex  type  were  often  so 
deftly  fashioned  as  to  be  very  realistic,  the  part  represent- 
ing the  gum  being  colored.  Unfortunately  no  dye  nor 
color  in  the  mouth  could  be  made  permanent. 

Elephant-ivory. — This  was  used  for  the  cheaper  grades 
of  work,  being  less  durable. 

Bone. — Bone  was  still  more  objectionable,  and  was 
used  for  only  the  cheapest  work. 

Artificial  porcelain  teeth  were  first  introduced  in  France 
in  177-t  and  in  America  in  1817.     Those  which  were  first 


POSITION    OF   THE   PROFESSION    OF   DENTISTRY.  335 

made  were  so  large,  awkward,  rough,  and  ill-fashioned, 
without  attempt  to  represent  the  gum,  as  to  bear  no  com- 
parison to  the  artistic  products  of  to-day.  They  were  in- 
tended for  the  most  part  for  attachment  to  ivory  bases. 
The  artificial  dentures  made  for  George  Washington  were 
of  this  general  character,  and,  although  they  called  forth 
his  encomiums  in  a  letter  to  his  dentist  expressing  his 
gratitude,  they  would  pass  for  very  shabby  productions  to- 
day. One  of  the  greatest  advances  in  dentistry  was  the 
introduction  of  gold  bases  as  a  substitute  for  the  base- 
plates previously  made  of  ivory  or  bone.  This  is  distinctly 
an  American  invention,  and  is  to  be  credited  to  Gardette, 
of  Philadelphia,  who  produced  the  first  bases  of  this  kind 
in  1787.  Since  then  other  metals  have  been  used  only 
because  cheaper,  none  having  the  valuable  properties  of 
gold. 

Gutta-percha  was  introduced  for  this  and  various  dental 
purposes  in  England,  in  1851,  by  Trueman.  In  1851,  too, 
came  Goodyear's  process  of  vulcanizing,  which  the  dental 
profession  were  at  first  slow  to  avail  themselves  of,  but 
which  led,  as  its  value  was  recognized  later,  to  expensive 
and  almost  endless  litigation. 

Another  most  valuable  American  invention  was  that 
of  taking  impressions  by  the  use  of  plaster.  This  was 
introduced  about  18-14-'45.  This  method  permitted  the 
making  of  socket-plates,  which,  of  itself,  was  a  long  step 
in  advance. 

So  much  for  a  very  brief  epitome  of  some  of  the  most 
interesting  facts  in  the  history  of  dentistry.  Did  time  per- 
mit, the  matter  would  warrant  treatment  at  much  greater 
length.  But  what  now  is  to  be  said  of  the  condition  of 
dentistry  to-day  1  First  of  all,  that  it  is  no  longer  rele- 
gated to  charlatans  and  itinerants,  but  is  studied,  practiced, 
and  honored  by  men  of  the  ablest  minds  and  of  the  highest 
type.  There  is  to-day  scarcely  any  branch  of  applied 
science  which  calls  for  greater  qualifications  or  for  greater 


336  THE    HISTORY    OF    MEDICINE. 

combination  of  mental  endowment  and  manual  dexterity 
than  does  dentistry.  We,  in  New  York,  find  onrselves 
now  in  position  wliere  tlie  State  has  assumed  not  only  to 
regulate  tlie  practice  of  dentistry,  but  even  to  pass  upon 
the  qualifications  of  those  who  propose  to  study  it.  In  the 
assumption  of  this  task  by  the  State  there  is  paid,  perhaps, 
the  greatest  possible  compliment  to  its  dignity  and  to  its 
importance. 

The  great  field  of  medicine  is  now  altogether  too  vast, 
and  the  various  branches  which  pertain  to  it  are  too  com- 
plex, to  permit  a  mastery  of  all  its  details  by  any  one  mind. 
The  man  does  not  live  who  to-day  can  be  considered  facile 
prlnceps  in  more  than  a  few  departments  of  medicine. 
Life  is  too  shprt  to  permit  of  it,  and  the  study  is  altogether 
too  extensive.  There  is  also  a  growing  public  demand  for 
specialization  of  work,  and  there  is  probably  more  excuse 
for  the  |)erpetuation  of  dentistry  as  a  specialty  than  for 
almost  any  other  branch.  Nevertheless,  it  is  necessary 
constantly  to  repress  a  tendency  toward  a  failure  to  com- 
preliend  the  genei*al  principles  underlying  all  medical 
specialties,  and  it  has  been  hard,  at  least  until  recently,  to 
impress  upon  the  men  of  the  dental  profession  that  they 
were  really  only  practicing  a  branch  of  medicine,  and  that, 
in  disregarding  a  general  and  comprehensive  knowledge 
of  the  fundamental  branches,  tliey  were  but  poorly  pre- 
paring themselves  for  the  practice  of  a  dignified  specialty. 
Certainly  dentistry  makes  as  many  demands  for  mechanical 
training,  digital  dexterity,  familiarity  with  the  properties 
of  materials,  etc.,  as  does  surgery,  and  in  some  respects 
even  more.  Of  course,  to  a  certain  extent  in  these  respects 
it  is  like  a  mechanical  trade.  The  great  trouble  with  the 
dental  profession,  until  very  recent  times,  is  that  they  have 
regarded  their  work  too  much  as  a  trade  and  not  enough 
as  a  profession.  By  taking  the  latter  view  of  it  the  work 
is  ennobled  and  their  interest  for  it  cultivated.  By  taking 
the  trade  view  of  it   tliev  have  lost   those  finer   features 


DENTISTRY    AS   A   SPECIALTY   OF    MEDICINE.  337 

which  lift  mechanical  work  out  of  the  mere  level  of  a 
trade.  Moreover,  men  in  time  past  have  been  guilty  of 
altogether  too  much  trades-union  tactics,  which  are  ve- 
hemently opposed  to  professional  ethics,  and  this  has  been 
another  feature  to  degrade  rather  than  elevate  dentistry. 

This  has  been  indeed  a  great  misfortune,  for  men  have 
been  misled  by  the  need  for  cultivation  of  their  hands,  or 
their  manual  powers,  and  have  been  persuaded  away  from 
a  finer  study  of  fundamental  principles  upon  which  the 
whole  practice  of  dentistry  should  be  based.  And  so  it 
has  happened  that  men  have  been  so  ambitious  to  become 
perfect  operators  that  they  have  neglected  anatomy,  physi- 
ology, chemistry,  and  pathology,  have  even  neglected 
odontology,  sacrificing  everything  else  to  their  work  as 
mere  artificers. 

If  one  scrutinizes  the  subject  properly,  there  is  no 
reason  why  there  should  not  grow  up  a  class  of  men  fitted 
to  attend  to  any  lesion  of  the  mouth  or  of  the  parts  adjoin- 
ing. In  other  words,  there  is  no  reason  why  there  is  not 
more  excuse  for  true  oral  surgeons  than  there  is  for  any 
other  class  of  specialists,  save  possibly  those  who  treat  the 
eye.  Aural  surgery,  nasal  surgery,  pelvic  surgery,  rectal 
surgery,  etc.,  are  simply  voluntary  limitations  and  appli- 
cations of  general  surgery  to  special  parts ;  but  he  who 
attends  to  the  teeth  has  to  do  so  much  work  of  a  character 
which  the  surgeon  is  not  called  upon  to  perform  in  any 
other  area,  that  I  have  always  claimed  the  oral  surgeon 
deserved  a  place,  as  he  had  a  field,  by  himself.  Neverthe- 
less, the  knowledge  which  shall  fit  a  man  for  such  work  is 
not  to  be  obtained  in  the  ordinary  dental  course,  nor  in 
three  years  of  study,  even  under  the  best  of  auspices.  The 
man  who  would  be  an  ideal  oral  surgeon  must  be  not  only 
generally  familiar  with  anatomy  and  physiology,  but  must 
thoroughly  know  the  embryology  of  the  face  and  teeth,  the 
physiology  not  alone  of  the  organs  of  the  mouth,  but  of 
all  the  secreting  glands  and  the  chemistry  of  all  their 


338  THE   HISTORY   OF   MEDICINE. 

secretions ;  not  only  the  anatomy  of  the  cranium,  but  gen- 
eral anatomy  as  well,  and  even  comparative  anatomy.  He 
must  be  well  informed  in  the  explanations  of  all  the  con- 
genital defects  met  about  the  face  and  mouth  ;  he  must  be 
familiar  not  only  with  the  ordinary  principles  of  pathology 
and  bacteriology,  but  he  will  find  in  the  fluids  about  the 
mouth  such  a  fertile  opportunity  for  bacteriological  study 
that,  be  he  ever  so  exi)ert  or  erudite,  he  has  still  much  lefl 
to  investigate  in  this  direction.  There  is  no  disease-germ 
with  which  he  can  aftbrd  to  be  unfamiliar,  and,  as  any 
form  of  tumor  may  be  found  in  or  about  the  mouth,  he 
should  be  lamiliar  with  the  entire  subject  of  tumors  and 
their  surgical  treatment. 

Then,  again,  he  must  be  familiar  not  only  with  the 
physical  properties  of  metals  and  the  various  materials  used 
in  plastic  dentistry,  nor  expert  alone  in  the  operations 
about  the  teeth,  but,  inasmuch  as  he  has  to  cope  with 
various  wounds,  injuries,  and  operations  about  the  soft 
parts,  he  must  be  thoroughly  familiar  with  the  principles  of 
wound-healing  ;  with  the  causes  of  sepsis  and  the  agents 
which  produce  it,  and  the  means  of  avoiding  it ;  in  other 
words,  he  must  have  a  general  training  in  operative  sur- 
gery, and,  according  to  my  ideal,  which  may  be  high,  he 
should  be  a  man  able  to  do  almost  any  operation  in  sur- 
gery before  he  limits  himself  to  surgery  of  the  mouth. 
Unless  he  have  this  ability,  he  will  not  do  such  operation  as 
well  as  a  general  surgeon  can,  because  the  underlying  prin- 
ciples are  the  same,  and  the  latter  will  have  the  greater 
command  over  them. 

When,  then,  this  perhaps  ideal  man  has  become 
thoroughly  familiar  with  the  principles  of  surgical  anat- 
omy, operative  surgery,  surgical  pathology,  and  bacteri- 
ology, in  addition  to  the  things  already' mentioned,  then, 
and  not  until  then,  may  he  and  should  he  assume  to 
operate  for  harelip,  cleft  palate,  cancer  of  the  tongue,  and 
various  other  lesions  in  the  parts  about  the  mouth. 


FOREIGN    REGARD   FOR   AMERICAN    DENTISTS.  339 

I  wisli  I  could  say  and  demonstrate  more  to  impress 
upon  you  the  important  bearing  of  modern  surgical  pa- 
thology to  dentistry.  Perhaps  I  can  give  you  no  better 
illustrations  than  you  can  see  in  the  studies  and  writings  of 
Prof.  W.  D.  Miller,  of  Berlin,  of  whom  I  am  proud  to  say 
that  he  is  an  American,  and  that  he  is  the  only  American 
occupying  a  professorship  in  a  German  university.  In  his 
studies  on  the  causes  of  dental  caries  and  upon  the  bacteria 
of  the  mouth  he  has  identified  and  named  nearly  a  hun- 
dred species  of  the  bacteria,  many  of  which  he  has  shown 
to  be  the  active  causes  of  dental  decay.  He  has  done, 
then,  for  dental  pathology  in  this  direction  what  other 
eminent  observers  have  done  for  the  processes  of  suppu- 
ration and  ulceration  in  other  textures  and  tissues,  and  lias 
helped  to  show  that  they  are  all  evidences  of  pernicious 
germ  activity.  By  his  researches,  also,  upon  inflammation 
in  elephant-tusks,  and  the  results  of  injury,  mainly  by 
bullet  wounds,  he  has  shown  us  that  the  phenomena  at- 
tending these  changes  in  dental  tissues  are  practically  iden- 
tical with  those  in  bone.  His  researches  have  done  very 
much  to  explain  the  pathology  of  that  common  disease, 
pyorrhcea  alveolaris,  which  is  known  to  be  but  one  expres- 
sion of  local  infection,  while  the  possibility  of  migration  of 
infectious  organisms  and  of  metastatic  lesions  in  other  parts 
of  the  body,  having  their  origin  in  infectious  disease  in  or 
near  the  teeth,  has  been  brilliantly  demonstrated  by  his 
interpretation  of  well-known  clinical  facts. 

That  American  dentists  are  most  highly  regarded 
abroad  is  more  than  a  matter  of  every-day  knowledge. 
It  has  got  to  be  so  now  that  a  foreigner  will  purchase  in- 
struments of  American  make,  and  then  advertise  himself 
as  an  American  dentist  for  the  purpose  of  getting  business, 
— ^a  purpose  in  which,  as  a  rule,  he  is  quite  successful. 
But  let  me  stop  here  to  do  honor  to  another  American 
dentist  who  is  more  highly  honored  abroad  than  one  ever 
can  be  at  home,  and  of  whom  it  might  be  said,  perhaps. 


340  THE   HISTORY    OF    MEDICINE. 

that  he  has  had  more  friends  among  the  royalty  and 
nobility  of  Europe  than  any  other  man  of  his  time.  This 
is  Ur.  Evans,  who  has  lived  for  years  in  Paris,  who  was  the 
personal  friend  of  Napoleon  III  and  the  trusted  guide  and 
companion  of  the  Empress  Eugenie  when  she  fled  from 
Paris.  While  it  may  be  said  of  him  that  the  qualities  that 
made  him  so  universally  popular  were  personal  qualities, 
rather  than  professional  knowledge,  it  must  be  said  in  reply 
that  it  was  his  eminent  professional  attainment  which  first 
brought  him  such  influential  friends. 

But  time  presses,  and  I  want,  before  closing,  to  say  a 
little  about  dentistry  in  America.  It  was  about  1835  that 
Dr.  Harris,  then  residing  in  Baltimore,  though  born  near 
Syracuse,  conceived  the  modern  idea  of  the  scope  and  prac- 
tice of  dentistry.  He  was  ambitious  to  put  the  dentists  of 
his  time  upon  a  higher  professional  level,  and  to  make  of 
dentistry  a  specialty  in  medicine.  He  applied  to  various 
medical  schools  to  found  dental  chairs,  and  to  teach  oral 
pathology  along  with  dental  mechanics,  as  one  of  the 
branches  of  medicine,  the  graduating  degree  to  be  M.D., 
as  with  other  medical  specialties.  But  the  men  of  his 
time  were  so  short-sighted  and  of  such  constricted  mental 
calibre,  and  the  dentists  were  so  uneducated,  that  the  Balti- 
more schools  declined.  He  therefore  established  a  separate 
school,  being  forced  to  take  this  step.  This  school  was 
the  Baltimore  College  of  Dental  Surgery,  established  in 
1839,^ — the  first  in  any  country.  The  dentistry  of  that  day 
was  crude,  and  its  teaching  was  comparatively  ineflicient. 
It  was  not  until  six  years  later  that  the  next,  the  Cincinnati 
College  of  Dental  Surgery  was  organized, — in  1845.  Then, 
in  time,  followed  Philadelphia.  But  all  these  colleges  were 
separate  institutions,  teaching  only  those  branches  which  it 
was  held  necessary  that  a  dentist  should  know  and  having 
very  little  of  medicine  in  their  curriculum.  They  conferred 
the  degree  of  D.D.S. 

In  1868  Harvard  University  did  what   she  ought  to 


DENTISTRY   IN    AMERICA.  341 

have  done  at  the  outset.  She  opened  a  dental  department 
and  began  the  teaching  of  dentistry  as  a  branch  of  medicine, 
establishing  therefor  a  separate  degree, — D.M.D., — Den- 
tarice  Medicince  Doctor.  In  1874  the  University  of 
Michigan  established  a  dental  department,  and  a  little 
later  the  University  of  Pennsylvania  did  the  same.  These 
university  schools  gave  an  immensely  widened  scope  to 
the  study,  which  was  made  broader  with  each  succeeding 
year. 

There  are  now  forty-five  dental  colleges  in  the  United 
States.  Forty  of  these  are  members  of  the  National 
Association  of  Dental  Faculties,  organized  for  the  purpose 
of  securing  uniformity  in  teaching  and  in  graduating  men. 
Membership  in  this  association  is  a  certificate  of  higli 
standing  and  of  comprehensive  advantages. 

Last  year  (1894)  the  number  of  students  in  dental  col- 
leges was  4979,  while  the  number  of  graduates  was  1208. 
At  present  nearly  all  the  States  have  legislation  governing 
the  practice  of  dentistry,  and  often  more  strict  than  that 
regulating  the  practice  of  medicine.  In  New  York  the 
law  places  dentistry  on  precisely  the  same  plane  as  medi- 
cine,— prescribes  the  same  qualifications  for  matriculation, 
the  same  length  of  study,  exactions  for  graduation,  exam- 
ination, etc.  In  other  words,  the  law  is  quite  as  strict 
regarding  admission  to  dental  colleges  as  to  medical. 
After  1897  at  least  a  full  high-school  course  will  be 
demanded  for  matriculation,  and  from  now  on  we  may 
look  forward  to  having  a  really  educated  dental  profession. 


CHAPTER  XV. 


lATKOTHEURGIC  SYMBOLISM. 
A  Historico-Critical  Supplement. 

Attention  is  invited  in  this  supplementary  chapter  to  a  subject 
which  has  always  been  of  the  greatest  interest  to  the  writer,  yet  upon 
which  it  has  been  difficult,  without  great  labor  and  numerous  books, 
to  get  much  information.  If  I  were  to  attempt  to  formulate  this  topic 
under  a  distinctive  name  1  could,  perhaps,  call  it  Medico-Christian 
Symbolism.  It  is  well  known  to  scholars  that  practically  all  of  the 
symbols  and  sjTnbolism  of  Christianity  have  come  from  pagan  sources, 
liaving  been  carried  over,  as  one  might  say,  across  the  line  of  the 
Christian  era,  from  one  to  the  other,  in  the  most  natural  and  unavoid- 
able way,  though  most  of  these  symbols  and  caricatures  have  more 
or  less  lost  their  original  signification  and  have  been  given  another 
of  purely  Christian  import. 

To  acknowledge  that  this  is  so  is  to  cast  no  slur  upon  Christianity ; 
it  is  simply  recording  a  historical  fact.  It  would  take  me  too  far  from 
my  purpose  were  I  to  go  into  the  events  which  have  brought  about 
this  change;  I  simply  want  to  disavow  all  intention  of  making  light 
of  serious  things,  or  of  reflecting  in  any  way  upon  the  nobility  of  the 
Christian  Church,  its  meanings,  or  its  present  practices.  But,  ac- 
cepting the  historical  fact  that  Christian  symbols  were  originally 
pagan  caricatures,  we  must  study  the  original  signification  of  these 
pagan  symbols,  especially  since  it  can  be  shown  that  almost  all  of  these 
emblems  had  originally  an  essentially  medical  significance,  referring 
in  some  way  or  other  either  to  questions  of  health  and  disease,  or 
else  to  the  deeper  question  of  the  origin  of  mankind  and  the  great 
generative  powers  of  nature,  at  which  physicians  wonder  to-day  as 
much  as  they  did  two  thousand  years  ago.  Considering,  then,  the 
medical  significance  of  such  study.  I  have  been  tempted  to  incur  the 
charge  of  being  pedantic  and  have  coined  for  it  the  term  lafrotheurgic 
Symholism. 

(342) 


lATROTHEURGIC  SYMBOLISM.  343 

As  Inman  says,  Moderns  who  have  not  been  initiated  in  the  sacred 
mysteries  and  only  know  the  emblems  considered  sacred,  have  need 
of  both  anatomical  knowledge  and  physiological  lore  ere  they  can  see 
the  meaning  of  many  signs.  The  emblems  or  symbols,  then,  to  which 
I  shall  particularly  refer  are  the  Cross,  the  Tree  and  Grove,  the  Fish, 
the  Dove,  and  the  Serpent.  And  first  of  all  the  Cross,  about  which 
very  erroneous  notions  prevail.  It  is  seen  everywhere  either  as  a 
matter  of  personal  or  church  adornment,  or  as  an  architectural  feature, 
and  everywhere  the  impression  prevails  that  it  is  exclusively  a  Chris- 
tian symbol.  This,  however,  is  the  grossest  of  errors,  for  the  world 
abounds  in  cruciform  symbols  and  monuments  which  existed  long 
before  Christianity  was  founded.  It  is  otherwise,  however,  with 
the  Crucifix,  which  is,  of  course,  an  absolutely  Christian  symbol.  The 
image  of  a  dead  man  stretched  out  upon  the  cross  is  a  purely  Christian 
addition  to  a  purely  pagan  emblem,  though  some  of  the  old  Hindoo 
crosses  remind  one  of  it  very  powerfully.  No  matter  upon  which 
continent  we  look,  we  see  everywhere  the  same  cruciform  sign  among 
peoples  and  races  most  distinct.  There,  perhaps,  has  never  been  so 
universal  a  symbol,  with  the  exception  of  the  serpent.  Moreover,  the 
cross  is  a  sort  of  international  feature,  and  is  spoken  of  in  its  modifi- 
cations as  St.  Andrew's,  St.  George's,  the  Maltese,  the  Greek,  the 
Latin,  etc.  Probably  because  of  its  extreme  simplicity,  the  ages  have 
brought  but  little  change  in  its  shape,  and  the  bauble  of  the  jeweler 
of  to-day  is  practically  the  same  sign  that  the  ancient  Egyptian  painted 
upon  the  mummy-cloth  of  his  sacred  dead.  Thus  it  will  appear  that 
the  shadow  of  the  cross  was  cast  far  back  into  the  night  of  ages.  The 
Druids  consecrated  their  sacred  oak  by  cutting  it  into  the  shape  of  a 
cross,  and  when  the  natural  shape  of  the  tree  was  not  sufficient  it  was 
pieced  out  as  the  case  required.  When  the  Spaniards  invaded  tbis 
continent  they  were  overcome  with  surprise  at  finding  the  sign  of 
the  cross  everywhere  in  common  use.  It  was  by  the  community  of  this 
emblem  between  the  two  peoples  that  the  Spaniards  enjoyed  a  less 
warlike  reception  than  would  otherwise  have  been  accorded  to  them. 

That  the  cross  was  originally  a  phallic  emblem  is  proved  among 
other  things  by  the  origin  of  the  so-called  Maltese  cross,  which  origi- 
/nally  was  carved  out  of  solid  granite,  and  represented  by  four  huge 
phalli  springing  from  a  common  center,  which  were  afterward  changed 
by  the  Knights  of  St.  John  of  Malta  into  four  triangles  meeting  at  a 
central  globe;  thus  we  see  combined  the  symbol  of  eternal  and  the 
emblem  of  constantlv-renovating  life.     The  reason  why  the  Maltese 


344  THE    HISTORY    OF    MEDICINE. 

cross  had  so  distinctly  a  phallic  origin,  and  why  the  Knights  of  St. 
John  saw  fit  to  make  something  more  decent  of  it,  is  not  clear,  but  a 
study  of  Assyrian  antiquities  of  the  days  of  Nineveh  and  Babylon 
shows  that  it  referred  to  the  four  great  gods  of  the  Assyrian  Pantheon, 
and  that  wdth  a  due  setting  it  signifies  the  sun  ruling  both  the  earth 
and  the  heavens.  Schlieman  discovered  many  examples  of  it  on  the 
vases  which  he  exhumed  from  the  ruins  of  Troy. 

But  probably  the  most  remarkable  of  all  crosses  is  that  which  is 
exceedingly  common  upon  Egyptian  monuments  and  is  known  as  the 
Crux-ansata, — that  is,  the  handled  cross, — which  consisted  of  the 
ordinary  Greek  Tav,  or  cross,  with  a  ring  on  the  top.  When  the 
Egyptian  was  asked  what  he  meant  by  this  sign  he  simply  replied 
that  it  was  a  divine  mystery,  and  such  it  has  largely  remained  ever 
since.  It  was  constantly  seen  in  the  hands  of  Isis  and  Osiris.  In 
nearly  the  same  shape  the  Spaniards  found  it  when  they  first  came  to 
this  continent.    The  natives  said  that  it  meant  "Life  to  come." 

In  the  British  ^luseum  one  may  see  in  the  Assyrian  galleries 
effigies  in  stone  of  certain  kings,  from  whose  necks  are  suspended 
sculptured  Maltese  crosses,  such  as  the  Catholics  call  the  "Pectoral 
Cross."  In  Eg}'pt,  long  before  Christ,  the  sacred  Ibis  was  represented 
with  human  hands  and  feet,  holding  the  staff  of  Isis  in  one  hand  and 
the  cross  in  the  other.  The  ancient  Eg}'ptian  and  astronomical  signs 
of  planets  contained  numerous  crosses.  Saturn  was  represented  by 
a  cross  surmounting  a  ram's  horn.  Jupiter  by  a  cross  beneath  a  horn, 
Venus  by  a  cross  beneath  a  circle  (practically  the  Crux-ansata),  the 
earth  by  a  cross  within  the  circle,  and  Mars  by  a  circle  beneath  the 
cross;  many  of  these  signs  are  in  use  to-day.  Between  the  Buddhist 
crosses  of  India  and  those  of  the  Roman  church  are  remarkable  resem- 
blances; the  former  were  frequently  placed  upon  a  Calvary,  as  is  the 
Catholic  custom  to-day.  The  cross  is  found  among  the  hieroglyphics 
of  China  and  upon  Chinese  pagodas,  and  upon  the  lamps  with  which 
they  illuminated  their  temples.  Upon  the  ancient  Phoenician  medals 
were  inscribed  the  cross,  the  rosary,  and  the  lamb.  In  England  there 
has  been  for  a  long  time  the  custom  of  eating  the  so-called  Hot-Cross 
Buns  upon  Good  Friday;  this  is  no  more  than  a  reproduction  of  a  cake 
marked  with  a  cross,  which  used  to  be  duly  offered  to  the  serpent  and 
the  bull  in  heathen  temples,  as  to  living  idols.  It  was  made  of  flour 
and  milk,  or  oil,  and  was  often  eaten  with  much  ceremony  by  priests 
and  people. 

Perhaps  the  most  ancient  of  all  forms  of  the  cross  is  the  cruci- 


lATROTHEURGIC  SYMBOLISM.  345 

form-hammer,  known  sometimes  as  Thor's  Battle-ax.  In  this  form  it 
was  venerated  by  the  heroes  of  the  North  as  a  magical  sign  which 
thwarted  the  power  of  death  over  those  who  bore  it.  Even  to-day  it 
is  employed  by  the  women  of  India  and  certain  parts  of  Africa  as 
indicating  the  possession  of  a  taboo  with  which  they  protect  their 
property.  It  has  been  stated  that  this  was  the  mark  which  the  prophet 
was  commanded  to  impress  upon  the  foreheads  of  the  faithful  in 
Judah.  (Ezekiel,  ix,  4.)  It  is  of  interest,  also,  as  being  almost  the 
last  of  the  purely  pagan  symbols  to  be  religiously  preserved  in  Europe 
-long  after  the  establishment  of  Christianit}',  since  to  the  close  of  the 
Middle  Ages  the  Cistercian  monk  wore  it  upon  his  stole.  It  may  be 
seen  upon  the  bells  of  many  parish  churches,  where  it  was  placed  as  a 
magical  sign  to  subdue  the  vicious  spirit  of  the  tempest. 

The  original  cross,  no  matter  what  its  form,  had  but  one  meaning: 
it  represented  creative  power  and  eternity.  In  Egypt,  Assyria,  and 
Britain,  in  India,  China,  and  Scandinavia,  it  was  an  emblem  of  life  and 
immortality;  upon  this  continent  it  was  the  sign  of  freedom  from 
suffering,  and  everywhere  it  symbolized  resurrection  and  life  to  come. 
Moreover,  from  its  common  combination  with  the  yoni  or  female  em- 
blem, we  may  conclude,  with  Inman,  that  the  ancient  cross  was  an 
emblem  of  the  belief  in  a  male  creator  and  the  method  by  which 
creation  was  initiated. 

Xext  to  the  cross,  the  Tree  of  Life  of  the  Egyptians  furnishes 
perhaps  the  most  ancient  and  universal  symbol  of  immortality.  The 
tree  is  probably  the  most  generally  received  symbol  of  life  and  has 
been  regarded  as  the  most  appropriate.  The  fig-tree  especially  has 
had  the  highest  place  in  this  regard.  From  it  gods  and  holy  men 
ascended  to  heaven;  before  it  thousands  of  barren  women  have  wor- 
shipped and  made  offerings;  under  it  pious  hermits  have  become  en- 
lightened and,  by  rubbing  together  fragments  of  its  wood,  have  drawn 
holy  fire  from  heaven. 

An  anonymous  Catholic  writer  has  stated:  "No  religion  is 
founded  upon  international  depravity.  Searching  back  for  the  origin 
of  life,  men  stopped  at  the  earliest  point  to  which  they  could  trace 
it  and  exalted  the  reproductive  organs  in  symbols  of  the  Creator. 
The  practice  was  at  least  calculated  to  procure  respect  for  a  side  of 
nature  liable,  under  an  exclusively  spiritual  regime,  to  be  relegated  to 
undue  contempt.  .  .  .  Even  Moses  himself  fell  back  upon  it 
when,  yielding  to  a  pressing  emergency,  he  gave  his  sanction  to  ser- 
pent worship  by  his  elevation  of  the  brazen  serpent  upon  a  pole  or 


346  THE    HISTORY    OF    MEDICINE. 

cross,  for  all  portions  of  this  structure  constituted  the  most  universally 
accepted  symbol  of  sex  in  the  world." 

As  perfectly  consistent  with  the  ancient  doctrine  that  deity  is 
both  male  and  female,  take  this  thought  from  Proclus,  who  quotes 
the  following  among  other  Orphic  verses:  "Jupiter  is  a  man;  Jupiter 
is  also  an  immortal  maid";  while  in  the  same  commentary  we  read 
that  "all  things  were  contained  in  the  womb  of  Jupiter." 

In  this  connection  it  was  quite  customary  to  depict  Jupiter  as  a 
female,  sometimes  with  three  heads;  often  the  figure  was  drawn  with 
a  serpent  and  was  venerated  under  the  symbol  of  fire.  It  was  then 
called  Mythra  and  was  worshipped  in  secret  caverns.  The  rites  of  this 
worship  were  quite  well  known  to  the  Romans. 

The  hermaphrodite  element  of  religion  is  sex  worship;  gods  are 
styled,  he,  she.  Synesius  gives  an  inscription  on  an  Egyptian  deity: 
"Thou  art  the  father  and  thou  art  the  mother;  thou  art  the  male  and 
thou  art  the  female."  Baal  was  of  uncertain  sex,  and  his  votaries 
usually  invoked  him  thus:  "Hear  us,  whether  thou  art  god  or  goddess." 
Heathens  seem  to  have  made  their  gods  hermaphrodites  in  order  to 
express  both  the  generative  and  prolific  virtues  of  their  deities.  I 
have  myself  heard  one  of  the  finest  living  Hindoo  scholars,  a  convert 
to  Christianity,  invoke  the  God  of  the  Christian  Church  both  as  father 
and  as  mother. 

The  most  significant  and  distinctive  feature  of  nature  worship 
certainly  had  to  do  with  phallic  emblems.  These,  viewed  in  the  light 
of  ancient  times,  simply  represented  allegorically  that  mysterious  union 
of  the  male  and  female  principle,  which  seems  necessary  to  the  exist- 
ence of  animate  things.  If  in  the  course  of  time  it  sadly  degenerated, 
we  may  lament  the  fact,  while,  nevertheless,  not  losing  sight  of  the 
purity  and  exalted  character  of  the  original  idea.  Of  its  extensive 
prevalence  there  is  ample  evidence,  since  monuments  indicating  such 
worship  are  spread  over  both  continents  and  have  been  recognized  in 
Egypt,  India,  Assyria,  Western  Europe,  Mexico,  Peru,  Hayti,  and  the 
Pacific  Islands.  Without  doubt  the  generative  act  was  originally  con- 
sidered as  a  solemn  sacrament  in  honor  of  the  Creator.  As  Knight 
has  insisted,  the  indecent  ideas  later  attached  to  it,  paradoxical  as  it 
may  seem,  were  the  result  of  the  more  advanced  civilization,  tending 
toward  its  decline,  as  we  see  in  Rome  and  Pompeii.  Voltaire,  speak- 
ing of  phallic  worship,  says:  "Our  ideas  of  propriety  lead  us  to  sup- 
pose that  a  ceremony  which  appears  to  us  so  infamous  could  only  be 
invented  by  licentiousness,  but  it  is  impossible  to  believe  that  depravity 


lATKOTHEURGIC  SYMBOLISM.  347 

of  manners  would  ever  lead  among  any  people  to  the  establishment 
of  religious  ceremonies.  It  is  probable,  on  the  contrary,  that  this 
custom  was  first  introduced  in  times  of  simplicity,  and  that  the  first 
thought  was  to  honor  a  deity  in  the  symbol  of  life  which  it  gives  us." 

The  so-called  Jewish  rite  of  circumcision  was  practiced  among 
Egyptians  and  Phrenicians  long  before  the  birth  of  Abraham.  It  had 
a  marked  religious  significance,  being  a  sign  of  the  Covenant,  and 
was  a  patriarchal  observance  because  it  was  always  performed  by  the 
head  of  the  family.  Indeed,  on  the  authority  of  the  Veda,  we  learn 
that  this  was  the  case,  also,  even  among  the  primitive  Aryan  people. 

Later  in  the  centuries,  as  Patterson  has  observed,  obscene  methods 
became  the  principal  feature  of  the  popular  superstition,  and  were, 
in  after-times,  even  extended  to  and  intermingled  with  gloomy  riterf 
and  bloody  sacrifices.  The  uiysteries  of  Ceres  and  Bacchus,  celebrated 
at  Eleusis,  were  probably  the  most  celebrated  of  all  the  Grecian  ob- 
servances. The  addition  of  Bacchus  was  comparatively  a  late  one, 
and  this  name  Bacchus  was  first  spelled  lacchos;  the  first  half,  lao, 
being  in  all  proba])ility  related  to  Jao,  which  appears  in  Jupiter  or 
Jovispater,  and  to  the  Hebrew  Yahve,  or  Jehovah.  Jao  was  the  har- 
vest-god, and  consequently  the  god  of  the  grape;  hence  his  close  re- 
lation to  Bacchus.  How  completely  these  Eleusinian  mysteries 
degenerated  into  Bacchic  orgies  is,  of  course,  a  matter  of  written 
history. 

I  have  not  yet  referred  to  the  reverence  paid  to  the  Fish,  both 
as  a  phallic  emblem  and  as  a  Christian  symbol.  The  supposition  that 
the  reason  why  the  fish  played  so  large  a  part  in  early  Christian  sym- 
bolism was  because  of  the  fact  that  each  letter  of  the  Greek  word 
Icthns  could  be  made  the  beginning  of  words  which,  when  fully  spelled 
out,  read  Jesus  Christ,  the  Son  of  God,  is  altogether  too  far-fetched; 
though,  if  it  be  true,  it  is  a  scholastic  trick  to  juggle  with  words 
in  this  way  rather  than  to  find  for  them  a  proper  signification.  Among 
the  Egyptians  and  many  other  nations,  the  greatest  reverence  was  paid 
to  this  animal.  Among  tlK-  natives,  the  rivers  which  contained  them 
were  esteemed  more  or  less  sacred;  the  common  people  did  not  feed 
upon  them,  and  the  priests  never  tasted  them,  because  of  their  reputed 
sanctity,  while  at  times  they  were  worshipped  as  real  deities.  Cities 
were  named  after  them,  and  temples  built  to  them.  In  different  parts 
of  Egypt  different  fishes  were  worshipped  individually;  the  Greek 
comedians  even  made  fun  of  the  Egyptians  because  of  this  fact.  Dagon 
figures  as  the  Fish-god,  and  the  female  deity  known  as  Athor,  in 


348  THE    HISTORY    OF    MEDICINE. 

Egypt,  is  undoubtedly  the  same  as  Aphrodite  of  the  Greeks  and  Venus 
of  the  Romans,  who  were  believed  to  have  sprung  from  the  sea. 
Lucian  tells  us  that  this  worship  was  of  great  antiquity.  Strange  as 
this  idolatry  may  appear,  it  was  yet  most  wide-spread,  and  included 
also  the  veneration  which  the  Egyptians,  before  Moses,  paid  to  the 
river  Mle. 

It  is  important  to  remember  that  Xun.  the  name  of  the  father 
of  Joshua,  is  the  Semitic  word  for  fish,  while  the  phallic  character 
of  the  fish  in  Chaldean  mythology  cannot  be  gainsaid.  Xim,  the 
planet  Saturn,  was  the  Fish-god  of  Berosus,  and  the  same  as  the 
Assyrian  god  Asshur,  whose  name  and  office  are  strikingly  similar  to 
those  of  the  Hebrew  leader  Joshua. 

Corresponding  to  the  ancient  phallus,  or  lingam,  which  was  the 
masculine  phallic  symbol,  we  have  the  Kteis,  or  Yoni,  as  the  symbol 
of  the  female  principle;  but  an  emblem  of  similar  import  is  often  to 
be  met  with  in  the  shape  of  the  shell,  the  fig-leaf,  or  the  letter  delta, 
as  may  be  frequently  seen  from  ancient  coins  and  monuments.  Similar 
attributes  were  at  other  times  expressed  by  a  bird,  using  the  dove 
or  sparrow,  which  will  at  once  make  one  think  of  the  prominence 
given  to  the  dove  in  the  fable  of  Xoah  and  the  Ark.  Referring  again 
to  the  fish-symbol,  let  me  say  that  the  head  of  Proserpine  is  very  often 
represented  surrounded  by  dolphins;  sometimes  by  pomegranates, 
which  also  have  a  phallic  significance.  In  fact,  Inman  in  his  work  on 
"Ancient  Faiths"  says  of  the  pomegranate:  "The  shape  of  this  fruit 
much  resembles  that  of  the  gravid  uterus  in  the  female,  and  the 
abundance  of  seeds  which  it  contains  makes  it  a  fitting  emblem  of  the 
prolific  womb  of  the  celestial  mother.  Its  use  was  largely  adopted  in 
various  forms  of  worship;  it  was  united  with  bells  in  the  adornment 
of  the  robes  of  the  Jewish  high-priest;  it  was  introduced  as  an  orna- 
ment into  Solomon's  Temple,  where  it  was  united  with  lilies  and  with 
the  lotus." 

■  Its  arcane  meaning  is  undoubtedly  phallic.  In  fact,  as  Inman 
has  stated,  the  idea  of  virility  was  most  closely  interwoven  with  re- 
ligion, though  the  English  Egj^ptologists  have  suppressed  a  portion  of 
the  facts  in  the  history  which  they  have  given  the  world;  but  the 
practice  which  still  obtains  among  the  negroes  of  Northern  Africa,  of 
mutilating  every  male  captive  and  slain  enemy,  is  but  a  continuance 
of  the  practice  mentioned  in  II  Kings,  xx,  18;  Isaiah,  xxxix,  7;  and 
I  Samuel,  xviii.  26. 

Frequently  in  Sacred  Scripture  we  find  reference  to  the  pillar  as 


lATROTHEURGlC  SYMBOLISM.  349 

a  most  sacred  emblem;  as,  for  example,  in  Isaiah,  xix,  19:  "In  that 
(lay  there  shall  be  an  altar  to  the  Lord  in  the  midst  of  the  land  of 
Egypt  and  a  pillar  to  the  border  thereof  to  Jehovah,"  etc.  Moreover, 
God  was  supposed  to  have  appeared  to  his  chosen  people  as  a  pillar  of 
fire.  Nevertheless,  when  among  idolatrous  nations  pillars  were  set 
up  as  a  part  of  their  rites,  we  find  them  noticed  in  Scripture  as  an 
abomination,  as,  for  example,  Deut.,  xii,  3:  "Ye  shall  overthrow  their 
altars  and  break  thir  pillars";  Levit.,  xxvi,  1:  "Neither  rear  ye  up  a 
standing  image." 

Among  the  Jews  the  pillar  had  much  the  same  significance  as 
the  pyramid  among  the  Egyptians  or  the  triangle  or  cone  among 
votaries  of  other  worships.  The  Tower  of  Eabel  must  have  been 
purely  a  mythical  creation,  but  in  the  same  direction.  x\lthough 
Abraham  is  regarded  as  having  emigrated  from  Chaldea  in  the  char- 
acter of  a  dissenter  from  the  religion  of  his  country  (see  Joshua  xxiv, 
2,  3),  his  immediate  descendants  apparently  had  recourse  to  the  sym- 
bols which  I  have  mentioned.  Thus  he  erected  altars  and  planted 
pillars  wherever  he  resided,  and  conducted  his  son  to  the  land  of 
Moriah  to  sacrifice  him  to  the  deity,  as  was  done  among  the  Phoeni- 
cians. Jeptha  in  like  manner  sacrificed  his  own  daughter  Mizpeh,  and 
the  Temple  of  Solomon  was  supposed  to  have  been  built  upon  the 
site  of  Abraham's  ancient  altar.  Jacob  not  only  set  up  a  pillar  at 
the  place  which  he  called  Bethel,  but  made  libations;  Samuel  wor- 
shipped at  the  high  places  at  Ramah,  and  Solomon  at  the  Great  Stone 
in  Gibeon.  It  remained  for  Hezekiah  to  change  the  entire  Hebrew 
cult.  He  removed  the  Dionysiac  statues  and  phallic  pillars,  as  well 
as  the  conical  and  omphallic  symbols  of  Venus  and  Ashtaroth,  and 
broke  in  pieces  the  brazen  serpent  of  Moses  and  overthrew  the  mounds 
and  altars.  After  him  Joshua  removed  the  paraphernalia  of  Sun 
worship  and  destroyed  the  statues  and  emblems  of  Venus  and  Adonis 
(II  Kings,  xxiii,  4-20). 

The  Greek  Hermes  was  identical  with  the  Egyptian  Khem,  as 
well  as  with  Mercury  and  with  Priapus;  also  with  the  Hebrew  Eloah. 
Thus,  when  Jacob  entered  into  a  covenant  with  Laban,  his  father-in- 
law,  a  pillar  was  set  up  and  a  heap  of  stones  made  and  a  certain  compact 
entered  into;  similar  landmarks  were  usual  with  the  Greeks  and  placed 
by  them  upon  public  roads. 

As  Mrs.  Childs  has  beautifully  said:  "Other  emblems  deemed 
sacred  by  Hindoos  and  worshipped  in  their  temples  have  brought  upon 
them  the  charge  of  gross  indecencies.    ...    If  light,  with  its  grand 


350  THE    HISTORY    OF    MEDICINE. 

revealings,  and  heat,  making  the  earth  fruitful  with  beauty,  excited 
wonder  and  worship  among  the  first  inhabitants  of  our  world,  is  it 
strange  that  they  likewise  regarded  with  reverence  the  great  mystery 
of  human  birth?  Were  they  impure  thus  to  regard  it?  Or  are  we 
impure  that  do  not  so  regard  it?"' 

Constant,  in  his  work  on  Roman  Polytheism,  says:  "Indecent  rites 
may  be  practiced  by  religious  people  with  the  greatest  purity  of  heart; 
but  when  incredulity  has  gained  a  footing  among  these  peoples,  then 
those  rites  become  the  cause  and  pretext  of  the  most  revolting  cor- 
ruption." 

The  phallic  symbol  was  always  found  in  Temples  of  Siva,  who 
corresponds  to  Baal,  and  was  usually  placed,  as  are  the  most  precious 
emblems  of  our  Christian  temples  to-day,  in  some  inmost  recess  of  the 
sanctuary.  Moreover,  lamps  with  seven  branches  were  kept  burning 
before  it,  these  seven-branched  lamps  long  antedating  the  golden 
candlestick  of  the  Mosaic  Tabernacle.  The  Jews  by  no  means  escaped 
the  objective  evidence  of  phallic  worship;  in  Ezekiel,  xvi,  17,  is  a  very 
marked  reference  to  the  manufacture  by  Jewish  women  of  gold  and 
silver  phalli. 

As  a  purely  phallic  symbol  and  custom,  mark  the  significance  of 
certain  superstitions  and  practices  even  now  prevalent  in  Great  Britain. 
Thus,  in  Boylase's  History  of  Cornwall,  it  is  stated  that  there  is  a  stone 
in  the  Parish  of  Mardon  with  a  hole  in  it  fourteen  inches  in  diameter, 
through  which  many  persons  creep  for  the  relief  of  pains  in  the  l^ack 
and  limbs,  and  through  which  children  are  drawn  to  cure  them  of 
rickets,  this  being  a  practical  application  of  the  doctrine  of  regener- 
ation. In  1888  there  was  printed  in  the  London  Standard  a  consider- 
able reference  to  passing  children  through  clefts  in  trees  as  a  curative 
measure  for  certain  physical  ailments.  The  same  practice  prevails  in 
Brazil  and  in  many  other  places,  and  within  the  present  generation  it 
has  been  customary  to  split  a  young  ash-tree,  and,  opening  this,  pass 
through  it  a  child  for  the  purpose  of  curing  rupture  or  some  other 
bodily  ailment. 

The  phallic  element  most  certainly  cannot  be  denied  in  Christi- 
anity itself,  since  in  it  are  many  references  which  are  unmistakable  to 
the  initiated.  From  the  fall  of  man,  with  its  serpent-myth  and  its 
phallic  foundation,  to  the  peculiar  position  assigned  to  the  Virgin 
Mary  as  a  mother  phallic  references  abound.  However,  it  should  not 
be  forgotten  that  whatever  were  the  primitive  ideas  on  which  these 
dogmas  were  based,  they  had  been  lost  sight  of,  or  had  been  received  in 


lATROTHEURGIC  SYMBOLISM.  351 

a  fresh  aspect  by  the  founders  of  Christianity.  The  fish  and  the  cross 
originally  typified  the  idea  of  generation,  and  later  that  of  life,  in 
which  sense  they  were  applied  to  Christ.  The  most  plainly  phallic 
representation  used  in  early  Christian  Iconography  is  undoubtedly  the 
Aureole,  or  elliptical  frame-work,  containing  usually  the  figure  of 
Christ,  sometimes  that  of  Mary.  The  Nimbus,  also,  generally  circular, 
but  sometimes  triangular,  is  of  positive  phallic  significance,  even 
though  it  contains  within  it  the  name  of  Jehovah.  The  sunflowers, 
which  sometimes  are  made  to  surround  the  figure  of  St.  John  the 
Evangelist,  are  the  lotus-flowers  of  the  Egyptians.  The  divine  hand, 
with  the  thumb  and  two  fingers  outstretched,  even  though  it  rests 
on  a  cruciform  nimbus,  is  a  phallic  emblem,  and  is  used  by  the 
Neapolitans  to-day  to  avert  the  Evil  Eye,  although  it  was  originally 
a  symbol  of  Isis.  Indeed,  the  Virgin  Mary  is  the  ancient  Isis,  as  can 
be  most  easily  established,  since  the  virgin  "succeeded  to  her  form, 
titles,  symbols,  rites,  and  ceremonies"  (King).  The  great  image  still 
moves  in  procession  as  when  Juvenal  laughed  at  it,  and  her  proper 
title  is  the  exact  translation  of  the  Sanskrit,  and  the  equivalent  of  the 
modern  Madonna,  the  Lotus  of  Isis,  and  the  Lily  of  the  modern 
Mary.  Indeed,  as  King  has  written:  "It  is  astonishing  how  much  of 
the  Egyptian  symbolism  passed  over  into  usages  of  the  following  times. 
The  high  cap  and  hooked  staff  of  the  god  became  the  bishop's  mitre 
and  crozier.  The  term  Nun  is  purely  Egyptian,  and  bore  its  present 
meaning.  The  Crux-ansata,  testifying  the  union  of  the  male  and 
female  principle  in  the  most  obvious  manner,  and  denoting  fecundity 
and  abundance,  is  transformed  by  a  simple  inversion  into  an  orb  sur- 
mounted by  a  cross,  the  ensign  of  royalty." 

The  teaching  of  the  Romish  Church  regarding  the  Virgin  Mary 
shows  a  remarkable  resemblance  to  the  teachings  of  the  ancients  con- 
cerning the  female  associate  of  the  triune  deity.  In  ancient  times  she 
has  passed  under  many  and  diverse  names;  she  was  the  Virgin,  con- 
ceiving and  bringing  forth  from  her  own  inherent  power;  she  was  the 
wife  of  Nimrod;  she  has  been  known  as  Athor,  Artemis,  Aphrodite, 
Venus,  Isis,  Cybele,  etc. 

As  Anaitis  she  is  mother  and  child,  appearing  again  as  Isis  and 
Horns;  even  in  ancient  Mexico  mother  and  cbild  were  worshipped. 
In  modern  times  she  reappears  as  the  Virgin  Mary  and  her  son;  she 
was  queen  of  fecundity,  queen  of  the  gods,  goddess  of  war,  Virgin  of 
the  Zodiac,  the  mysterious  Virgin  "Time,"  in  whose  womb  all  things 
were  born.     Although  variously  represented,  she  has  been  usually 


COLLI 


352  THE    HISTORY    OF    MEDICINE. 

pictured  as  a  more  or  less  nude  figure  carrying  an  infant  in  her  arms. 
(Inman,  "Ancient  Faiths.") 

Inman  declares  without  hesitation  that  the  trinity  of  the  ancients 
is  unquestionably  of  phallic  origin,  and  others  have  strenuously  con- 
tended and  apparently  proved  that  the  male  emblem  of  generation  in 
divine  creation  was  three  in  one,  and  that  the  female  emblem  has  al- 
ways been  the  triangle  or  accepted  symbol  of  trinity.  Sometimes  two 
triangles  have*  been  combined,  forming  a  six-rayed  star,  the  two  to- 
gether being  emblematical  of  the  union  of  the  male  and  female  prin- 
ciples producing  a  new  figure;  the  triangle  by  itself,  with  the  point 
down,  typifies  the  delta,  or  yoni,  through  which  all  things  come  into 
the  world. 

Another  symbol  of  deity  among  the  Indians  was  the  Trident,  and 
this  marks  the  belief  in  the  Trinity  which  very  generally  prevailed  in 
India  among  the  Hindoos.  As  Maurice  says,  "It  was,  indeed,  highly 
proper  and  strictly  characteristic  that  a  threefold  deity  should  wield  a 
triple  scepter."  Upon  the  top  of  the  immense  p}Tamids  of  Deogur, 
which  were  truncated,  and  upon  whose  upper  surface  rested  the  cir- 
cular cone — that  ancient  emblem  of  the  Phallus  and  of  the  Sun — was 
found  the  trident  scepter  of  the  Greek  Xeptune.  It  is  said  that  in 
India  is  to  be  found  the  most  ancient  form  of  Trinitarian  worship.  In 
Egypt  it  later  prevailed  widely,  but  scarcely  any  two  States  worshipped 
the  same  triad,  though  all  triads  had  this  in  common,  however,  that 
they  were  father,  mother,  and  son,  or  male  and  female,  with  their 
progeny.  In  the  course  of  time,  however,  the  worsliip  of  the  first 
person  was  lost  or  absorbed  in  the  second,  and  the  same  thing  is 
prevalent  among  the  Christians  of  to-day,  for  many  churches  and  insti- 
tutions are  dedicated  to  the  second  or  third  persons  of  the  Trinity, 
but  none  to  the  first. 

The  transition  from  the  old  to  the  new  could  not  be  effected  in 
a  short  time  and  must  have  been  an  exceedingly  slow  process;  there- 
fore we  need  not  be  surprised  to  be  told  of  the  ancient  worship  that 
after  its  exclusion  from  larger  places  it  was  maintained  for  a  long  time 
by  the  inhabitants  of  humbler  localities;  hence  its  subsequent  designa- 
tion, since  from  being  kept  up  in  the  villages,  the  pagi,  its  votaries 
were  designated  pagani,  or  pagans. 

Even  now  some  of  these  ancient  superstitions  remain  in  recog- 
nizable form.  The  moon  is  supposed  to  exert  a  baneful  or  lucky  influ- 
ence, according  as  it  is  first  viewed;  the  mystic  horseshoe,  which  is 
a  purely  uterine  83rmbol,  is  still  widely  employed;  lucky  and  unlucky 


lATROTHEURGIC  SYMBOLISM.  353 

days  are  still  regarded;  our  playing  cards  are  indicated  by  phallic 
symbols,  the  spade,  the  tradic  club,  the  omphallic  distaf  and  eminence 
disguised  as  the  heart  and  the  diamond.  Dionysius  reappears  as  St. 
Denys,  or  in  France  as  St.  Bacchus;  Satan  is  revered,  as  St.  Satur  or 
St.  S within;  the  Holy  Virgin  Astraea,  whose  return  was  heralded  by 
Virgil  as  introducing  the  golden  age,  is  now  designated  as  the  Blessed 
Virgin,  Queen  of  Heaven;  the  mother  and  child  are  to-day  in  Catholic 
countries  adored  as  much  as  were  Ceres  and  Bacchus,  or  Isis  and  the 
infant  Horus  centuries  ago.  The  Christian  nuns  of  to-day  are  the 
nuns  of  the  Buddhists  or  of  the  Egyptian  worshippers  of  Isis,  and  the 
phallic  import  is  not  lost  even  in  their  case,  since  they  are  the  "Brides 
of  the  Saviour."  The  libations  of  human  blood  which  were  formerly 
offered  to  Bacchus,  found  most  tragic  imitation  in  the  sacrifices  of  later 
days.  The  screechings  of  the  ancient  prophets  of  Baal,  and  of  the 
Egyptian  worshippers,  preceded  the  flagellations  of  the  penitents. 
Even  recently,  during  Holy  Week  in  Rome,  devotees  lash  themselves 
until  the  blood  runs,  as  did  the  young  men  in  ancient  Rome  during 
the  Lupercalia.  In  the  ancient  Roman  catacombs  are  found  portraits 
of  the  utensils  and  furniture  of  the  ancient  mysteries,  and  one  drawing 
shows  a  woman  standing  before  an  altar  offering  buns  to  a  certain 
god.  In  fact,  we  may  say  there  is  no  Christian  fast  nor  festival,  pro- 
cession nor  sacrament,  custom  nor  example,  that  does  not  come  from 
previous  paganism. 

Since  the  dawn  of  written  history,  and  from  the  most  remote 
periods,  the  Serpent  has  been  regarded  with  the  highest  veneration 
as  the  most  mysterious  of  living  creatures.  Being  alike  an  object  of 
wonder,  admiration,  and  fear,  it  is  not  strange  that  it  became  early 
connected  with  numerous  superstitions;  and  when  we  remember  how 
imperfectly  understood  were  its  habits  we  shall  not  wonder  at  tlie 
extraordinary  attributes  with  which  it  was  invested,  nor  perhaps  even 
how  it  obtained  so  general  a  worship.  Thus,  centuries  ago,  Horapollo, 
referring  to  serpent-symbolism,  said:  "When  the  Egyptians  were  rep- 
resenting a  universe  they  delineated  the  spectacle  as  a  variegated  snake 
devouring  its  own  tail,  the  scales  intimating  the  stars  in  the  universe, 
the  animal  being  extremely  heavy,  as  is  the  earth,  and  extremely  slip- 
pery like  the  water;  moreover,  it  every  year  puts  off  its  old  age  with 
its  skin,  as,  in  the  universe,  the  recurring  year  effects  a  corresponding 
change  and  becomes  renovated,  while  the  making  use  of  its  own  body 
for  food  implies  that  all  things  whatever  which  are  generated  by 
divine  providence  in  the  world  undergo  a  corruption  into  them  again." 


354       •  THE    HISTORY    OF    MEDICINE. 

lu  all  probability  the  annual  shedding  of  the  skin  and  the  sup- 
posed rejuvenation  of  the  animal  was  that  which  first  connected  it 
with  the  idea  of  eternal  succession  of  form,  subsequent  reproduction, 
and  dissolution.  This  doctrine  is  typified  in  the  notion  of  the  suc- 
cession of  ages  which  prevailed  among  the  Greeks  and  the  similar 
notions  met  with  among  nearly  all  primitive  peoples.  The  ancient 
mysteries,  with  few  or  perhaps  no  exceptions,  were  intended  to  illus- 
trate the  grand  phenomena  of  nature.  The  mysteries  of  Osiris,  Isis, 
and  Horus  in  Egypt:  of  Cybele  in  Phrygia;  of  Ceres  and  Proserpine 
at  Eleusis;  of  Venus  and  Adonis  in  Phoenicia;  of  Bona  Dea  and  of 
Priapus  in  Rome,  all  had  this  in  common,  that  they  both  mystified  and 
typified  the  creation  of  things  and  the  perpetuation  of  life.  In  all  of 
them  the  serpent  was  conspicuously  introduced,  as  it  symbolized  and 
indicated  the  invigorating  energy  of  nature.  In  the  mysteries  of  Ceres, 
the  grand  secret  which  was  communicated  to  the  initiates  was  put  in 
this  enigma:  "The  bull  has  begotten  a  serpent  and  the  serpent  a  bull," 
the  bull  being  a  prominent  emblem  of  generative  force.  In  ancient 
Egypt  it  was  usually  the  bull's  horns  which  served  as  a  symbol  for  the 
entire  animal.  \Mien  with  the  progress  of  centuries  the  bull  became 
too  expensive  an  animal  to  be  commonly  used  for  any  purpose,  the  ram 
was  substituted;  hence  the  frequency  of  the  ram's  horn  as  a  symbol 
for  Jove,  seen  so  frequently,  for  example,  among  Roman  antiquities. 

Originally  fire  was  taken  to  be  one  of  the  emblems  of  the  sun, 
and  most  naturally,  inevitably,  and  universally  the  sun  came  to  sym- 
bolize the  active,  vivifying  principle  of  nature.  That  the  serpent 
should  in  time  typify  the  same  principle,  while  the  egg  symbolized  the 
more  passive  or  feminine  element,  is  equally  certain,  but  less  ea.sy  of 
explanation;  indeed,  we  are  to  regard  the  serpent  as  the  symbol  of  the 
great  hermaphrodite  first  principle  of  nature.  "It  entered  into  the 
mythology  of  every  nation,  consecrated  almost  every  temple,  sym- 
bolized almost  every  deity,  was  imagined  in  the  heavens,  stamped  on 
the  earth,  and  ruled  in  the  realms  of  eternal  sorrow.'* 

The  close  relationship,  if  not  absolute  identity,  among  the  early 
races  of  man  between  Solar,  Phallic,  and  Serpent  worship  was  most 
striking;  so  marked,  indeed,  as  to  indicate  that  they  are  all  forms  of 
a  single  worship.  It  is  with  the  latter  that  we  must  for  a  while  concern 
ourselves.  How  prominent  a  place  serpent  worship  plays  in  our  own 
Old  Testament  will  be  remarked  so  soon  as  one  begins  to  reflect  upon 
it.  The  part  played  by  the  serpent  in  the  biblical  myth  concerning 
the  origin  of  man  is  the  fir^t  and  most  striking  illustration.    In  the 


lATROTHEUEGlC   SYMBOLISM.  •  355 

degenerated  ancient  ni^'steries  of  ]3aecliiis  some  of  .the  persons  who 
took  part  in  tlie  ceremonies  used  to  carr}^  serpents  in  their  hands,  and 
with  horrid  screams  call  "Eva,  Eva";  the  attendants  were,  in  fact, 
often  crowned  with  serpents  while  still  making  these  frantic  cries.  It 
has  been  held  that  the  invocation  "Eva"  related  to  the  great  mother 
of  mankind;  even  so  good  an  authority  as  Clemens  of  Alexandria  held 
to  this  o])inion;  but  Clemens  also  acknowledges  that  the  name  Eva, 
when  properly  aspirated,  is  practically  the  same  as  Epha,  or  Opha, 
which  is  the  Greek  Ophis,  which  is,  in  English,  Serpent.  In  most  of 
the  other  mysteries  serpent-rites  were  introduced,  and  many  of  the 
names  are  extremely  suggestive.  The  Abaddon  mentioned  in  the  book 
of  Eevelation  is  certainly  some  serpent-deity,  since  the  prefix  Ab  sig- 
nifies not  only  father,  but  serpent.  By  Zoroaster  the  expanse  of  the 
heavens  and  even  nature  itself  were  described  under  the  symbol  of  the 
serpent.  In  ancient  Persia  temples  were  erected  to  the  serpent-tribe, 
and  festivals  consecrated  to  their  honor,  some  relic  of  this  being  found 
in  the  word  Basilicus,  or  royal  serpent,  which  gives  rise  to  the  term 
Ba.siliea  applied  to  the  Christian  Churches  of  the  present  era.  The 
p]thiopians,  even,  of  the  present  day  derive  their  name  from  the  Greek 
Aithiopes,  meaning  the  serpent-gods  worshipped  long  before  them. 
Again,  the  island  of  Eubrea  signifies  the  Serpent  Island,  and  properly 
spelled  should  be  Oub-Aia.  The  Greeks  claimed  that  Medusa's  head 
was  brouglit  by  Perseus,  l)y  which  they  mean  the  serpent  deity,  as  the 
worship  was  introduced  into  Greece  by  a  people  called  Peresians.  The 
head  of  Medusa  denoted  divine  wisdom,  Avhile  the  island  Avas  sacred 
to  the  serpent.  The  worship  of  the  serpent  being  so  old,  many  places 
as  well  as  races  received  names  indicating  the  prevalence  of  this  gen- 
eral superstition;  but  this  is  no  time  to  catalogue  these,  though  one, 
perhaps,  should  mention  Ophis,  Oboth,  Eva  in  Mecedonia,  Dracontia, 
and  last,  but  not  least,  the  name  Eve  and  the  Garden  of  Eden. 

Whether  or  not  the  serpent-S3^mbol  has  a  distinct  phallic  refer- 
ence has  been  disputed;  but  the  more  the  subject  is  broadly  studied, 
the  more  it  woidd  seem  that  such  is  the  case.  It  must  certainly  appear 
that  the  older  races  had  that  form  of  belief  with  which  the  serpent 
M'as  always  more  or  less  symbolically  connected;  that  is,  adoration  of 
the  male  principle  of  generation,  one  of  whose  principle  phases  was 
undoubtedly  ancestor  worship,  while  somewhat  later  the  race  adored 
the  female  principle,  which  they  symbolized  by  the  sacred  tree  so 
often  mentioned  in  Scripture  as  the  Assyrian  Grove.  Whether  snakes 
be  represented  singly,  coupled  in  pairs — as  in  the  well-known  Cadu- 


356  THE    HISTORY    OF    MEDICINE. 

cells,  or  Rod  of  ^Esculapius — or  in  the  crown  placed  ii])on  the  head  of 
many  a  god  or  goddess,  or  the  nian\'-headed  snake  drinking  from  the 
jeweled  cup,  or  a  snake  twisted  around  a  tree  with  another  ajiproaching 
it,  suggesting  temptation  and  fall,  the  underlying  principle  is  always 
the  same.  S3'mhols  of  this  character  are  met  with  not  only  in  the 
temples  of  ancient  Egypt,  but  in  ruins  antedating  them  in  Persia  and 
the  East;  in  the  antiquities  belonging  to  the  races  that  first  peopled 
what  is  now  Greece  and  Italy,  in  the  Rock-markings  of  India  and  of 
Central  Europe,  in  the  Cromlechs  of  Great  Britain  and  Scandinavia,  in 
the  Great  Serpent  Mound  which  still  remains  in  Ohio,  and  in  many 
other  mounds  left  by  the  mound-builders  of  this  country,  in  the  ruins 
of  Central  America  and  Yucatan,  and  in  the  traditions  and  relics  of 
the  Aztecs  and  Toltecs;  in  fact,  wherever  antiquarian  research  has 
penetrated  or  where  monuments  of  ancient  peoples  remain.  There 
never  has  been  so  wide-spread  a  superstition,  and  no  matter  what  later 
forms  it  may  have  assumed,  we  must  admit  that  it,  first  of  all  and  for 
a  long  time,  was  man's  tribute  to  the  great,  all  powerful,  and  unknown 
regenerative  principle  of  nature,  which  has  been  deified  again  and 
again,  and  which  always  has  been,  and  probal)ly  always  will  be,  the 
greatest  mystery  within  the  ken  of  mankind. 

"This  religion,  void  of  reason,  condemned  in  the  wisdom  of  Solo- 
mon, probably  survived  even  the  Babylonian  captivity;  certainly  it 
was  adopted  by  the  sects  of  Christians  which  were  known  as  Ophites, 
Gnostics,  and  Xicolaitans." 

The  Creation  is,  in  fact,  a  human  rather  than  a  divine  product 
in  this  sense:  that  it  was  suggested  to  the  mind  of  man  by  the  exist- 
ence of  things,  while  its  method  was,  at  least  at  first,  suggested  by  the 
operations  of  nature;  thus,  man  saw  the  living  bird  emerge  from  the 
egfc,  after  a  certain  period  of  incubation,  a  phenomenon  equivalent  to 
actual  creation  as  apprehended  by  his  simple  mind.  Incubation  ob- 
viously, then,  associated  itself  with  Creation,  and  this  fact  will  explain 
the  universality  with  which  the  egg  was  received  as  a  symbol  in  the 
earlier  system  of  cosmogony.  By  a  similar  process  creation  came  to  be 
symbolized  in  the  form  of  a  phallus,  and  so  the  Egyptians,  in  their  re- 
finement of  these  ideas,  adopted  as  their  symbol  of  the  first  great  cause 
a  Scarabfpus,  indicating  the  great  hermaphrodite  unity,  since  they 
believed  this  insect  to  he  both  male  and  female. 

They  beautifully  typified  a  part  of  this  idea,  also,  in  the  adoration 
which  they  paid  to  the  water-lily,  or  Lotus,  so  generally  regarded  as 
sacred  throughout  the  East.    It  is  the  sublime  and  beautiful  symbol 


lATEOTUEURGIC   SYMBOLISM.  357 

which  perpetually  occurs  in  Oriental  mythology,  and,  as  Maurice 
stated,  not  without  substantial  reason,  for  it  is  its  own  beautiful 
prodigy  and  contains  a  treasure  of  physical  instruction.  The  lotus- 
flower  grows  in  the  water  among  broad  leaves,  while  in  its  center  is 
formed  a  seed-vessel  sliaped  like  a  bell,  punctured  on  the  top  with 
small  cavities  in  which  its  seeds  develop;  the  openings  into  the  seed- 
cells  are  too  small  to  permit  the  seeds  to  escape  when  ripe,  consequently 
they  absorb  moisture  and  develop  within  the  same,  shooting  forth  as 
ivew  plants  from  the  place  where  they  originated;  the  bulb  of  the  ves- 
sel serves  as  a  matrix  which  shall  nourish  them  until  they  are  large 
enough  to  burst  open  and  release  themselves,  after  which  they  take 
root  wherever  deposited.  "The  plant,  therefore,  being  itself  productive 
of  itself,  vegetating  from  its  own  matrix,  being  fostered  in  the  earth, 
was  naturally  adopted  as  a  symbol  of  the  productive  power  of  waters 
upon  which  the  creative  spirit  of  the  Creator  acted,  in  giving  life  and 
vegetation  to  matter.  We  accordingly  find  it  employed  in  every  part 
of  the  Northern  Hemisphere  where  symbolical  religion,  improperly 
called  idolatry,  existed." 

Further  exemplification  of  the  same  underlying  principle  is  seen 
in  the  fact  that  most  all  of  the  ancient  deities  were  paired;  thus  we 
have  heaven  and  earth,  sun  and  moon,  fire  and  earth,  father  and 
mother,  etc.  Faber  says:  "The  ancient  Pagans  of  almost  every  part 
of  the  globe  were  wont  to  symbolize  the  world  l)y  an  egg;  hence  this 
sj^mbol  is  introduced  into  the  cosmogonies  of  nearly  all  nations,  and 
there  are  few  persons,  even  among  those  who  have  made  mythology 
their  study,  to  whom  the  mundane  egg  is  not  perfectly  familiar;  it  is 
the  emblem  not  only  of  earth  and  life,  but  also  of  the  universe  in  its 
largest  extent."  In  tlie  island  of  Cypress  is  still  to  be  seen  a  gigantic 
egg-shaped  vase  which  is  supposed  to  represent  the  mundane  or 
Orphic  egg.  It  is  of  stone,  measuring  thirty  feet  in  circumference, 
and  has  a  sculptured  bull,  the  emblem  of  productive  energy,  which  is 
supposed  to  signify  the  constellation  Taurus,  whose  rising  was  con- 
nected with  the  return  of  the  mystic  reinvigorating  principle. 

The  work  of  the  mound-builders  in  this  country  is  generally  and 
widely  known;  still  it  is  perhaps  not  so  generally  known  how  common 
upon  this  continent  was  the  general  use  of  the  serpent-symbol.  Their 
remains  are  spread  over  the  country  from  the  sources  of  the  Alleghany 
in  New  York  westward  to  Towa  and  Nebraska,  to  a  considerable  extent 
through  the  Mississippi  Valley  and  along  the  Susquehanna  as  far  as  the 
Valley  of  Wyoming  in  Pennsylvania.    They  are  found  even  along  the 


358  THE    HISTORY    OF    MEDICINE. 

St.  Lawrence  River;  they  also  line  the  shore  of  the  Gulf  from  Florida 
to  Texas.  That  they  were  erected  for  other  than  defensive  purposes 
is  most  clear;  without  knowing  exactly  what  was  the  government  of 
their  builders,  the  presumption  is  that  it  combined  both  the  priesth' 
and  civil  functions,  as  obtained  centuries  ago  in  Mexico.  The  Great 
Serpent  ilound,  located  in  Ohio,  had  a  length  of  at  least  one  thou- 
sand feet;  the  outline  was  perfectly  regular  and  smooth,  and  the 
mouth  was  widely  open,  as  if  in  the  act  of  swallowing  or  ejecting  an 
oval  figure,  also  formed  of  earth,  whose  longest  diameter  was  one  hun- 
dred and  sixty  feet.  Again,  near  Granville,  Ohio,  occurs  the  form  of 
an  alligator,  in  connection  with  which  was  indubitable  evidence  of  an 
altar.  Xear  Tarlton,  Ohio,  is  another  earth-work  in  the  form  of  a 
cross.  There  is  every  reason  to  think  that  sacrifices  were  made  upon 
the  altars  nearly  always  found  in  connection  with  these  mounds. 
Among  the  various  animal  effigies  found  in  Wisconsin,  mounds  in  the 
form  of  serpents  are  most  frequently  met  with,  while  circles  inclosing 
a  pentagon  or  a  mound  with  eight  radiating  points,  undoubtedly  rep- 
resenting the  sun,  were  also  found. 

There  would  seem,  in  all  these  representations,  to  be  an  unmistak- 
able reference  to  that  form  of  early  cosmogony  in  which  every  vivifica- 
tion  of  the  mundane  egg  constituted  a  real  act  of  creation.  In  Japan 
this  conceptive  egg  is  allegorically  represented  by  a  nest-egg  shown 
floating  upon  an  expanse  of  water,  against  which  a  bulb  is  striking  with 
horns.  The  Sandwich  Islanders  have  a  tradition  that  a  bird,  which 
with  them  is  an  emblem  of  deity,  laid  an  egg  upon  the  waters,  which 
burst  of  itself  and  thus  produced  the  islands.  In  Egypt,  Kncph  was 
represented  as  a  serpent  emitting  from  his  mouth  an  egg,  from  which 
proceeds  the  divinity  Phtha.  In  the  Bible  there  is  frequent  reference 
to  seraphs;  Se  Ra  Ph  is  the  singular  of  seraphim,  meaning  splendor, 
fire,  or  light.  It  is  emblematic  of  the  fiery  sun,  which  under  the  name 
of  the  Serpent  Dragon  was  destroyed  by  the  reformer  Hezekiah:  or,  it 
means,  also,  the  serpent  with  wings  and  feet,  as  used  to  be  represented 
in  funeral  rituals. 

Undoubtedly  Abraham  brought  with  him  from  Chaldea  into 
lower  Eg3'pt  symbols  of  simple  phallic  deities.  The  references  in  the 
Bible  to  the  Teraphim  of  Jacob's  family  remind  us  that  Terah  was 
the  name  of  Abraham's  father  and  that  he  was  a  maker  of  images.  Un- 
doubtedh'  the  Teraphim  were  the  same  as  the  Seraphim;  that  is,  were 
serpent-images  and  were  the  household  charms  of  the  Semitic  wor- 
shippers of  the  sun-god  to  whom  the  serpent  was  sacred.    In  Numbers, 


lATROTHEURGlC   SYMBOLISM.  359 

xxi,  the  seri^ent-symbol  of  the  Exodus  is  called  a  seraph;  moreover, 
when  the  people  were  bitten  by  a  fiery  serpent,  Moses  prayed  for  them, 
when  Jehovah  replied:  "Make  them  a  fiery  serpent  (literally  seraph) 
and  set  it  upon  a  pole  and  it  shall  come  to  pass  that  every  one  who  is 
bitten  when  he  looketh  upon  it  shall  live."  The  exact  significance  of 
this  healing  figure  of  the  serpent  is  far  to  seek. 

In  this  connection  it  must  be  remembered,  also,  that  among  several 
of  the  Semitic  tongues  the  same  root  signifies  both  serpent  and  phallus, 
which  are  both  in  effect  solar  emblems.  Cronus  of  the  ancient  Orphic 
theogony,  probably  identical  with  Hercules,  was  represented  under  the 
mixed  emblem  of  a  lion  and  a  serpent,  or  often  a  serpent  alone.  He 
was  originally  considered  Supreme,  as  is  shown  from  his  being  called 
II,  which  is  the  same  as  the  Hebrew  El,  which  was,  according  to  St. 
Jerome,  one  of  the  ten  names  of  God.  Damascius,  in  his  life  of 
Isidorus,  mentions  that  Cronus  was  worshipped  under  the  name  of  El. 
Brahm,  Cronvis,  and  Kneph  each  represented  the  mystfcal  union  of  the 
reciprocal  or  active  and  passive  regenerative  principles. 

The  Semitic  deity  Seth  was  certainly  a  serpent-god,  and  can  be 
identified  with  Saturn  and  deities  of  other  people.  The  common  name 
of  God,  Eloah,  among  the  Hebrews  and  other  Semites  goes  back  to 
the  earliest  times;  indeed,  Bryant  goes  so  far  as  to  say  that  El  was  the 
original  name  of  the  supreme  deity  among  all  the  nations  of  the  East. 
He  was  the  same  as  Cronus,  who,  again,  was  the  primeval  Saturn. 
Thus  Saturn  and  El  were  the  same  deity,  and,  like  Setli,  were  sym- 
bolized by  the  serpent. 

On  the  Western  Continent  this  great  Unity  was  equally  recog- 
nized; in  Mexico  as  Teotl;  in  Peru  as  Varicocha,  or  the  Soul  of  the 
Universe;  in  Central  America  and  Yucatan  as  Stunah  Ku,  or  God  of 
Gods.  In  the  Aztec  Pantheon  all  other  gods  and  goddesses  were  prac- 
tically modified  impersonations  of  these  two  principles.  In  the  simpler 
mythology  of  Peru  these  principles  took  the  form  of  the  Sun  and  his 
wife  the  Moon. 

Among  the  annals  of  the  Mexicans  the  woman  whose  name  old 
Spanish  writers  translated  "The  Woman  of  our  Fish"  is  always  repre- 
sented as  accompanied  by  a  great  male  serpent.  This  serpent  is  the 
Sun-god,  the  principal  deity  of  the  Mexican  Pantheon,  while  tlie  name 
which  they  give  to  the  goddess-mother  of  primitive  man  signifies 
"Woman  of  the  Serpent." 

Inseparably  connected  with  the  serpent  as  a  phallic  emblem  are 
also  the  pyramids,  and,  as  is  well  known,  pyramids  abound  in  Mexico 


360  THE    HISTORY    OF    MEDICINE. 

and  Central  America.  As  Humboldt  years  ago  observed,  pyramids 
existed  through  Mexico,  in  the  forests  of  Papantha,  at  a  short  distance 
above  sea-level;  on  the  plains  of  Cholula  and  of  Teotihuacan,  at  an 
elevation  which  exceeds  those  of  the  passes  of  the  Alps.  In  most 
widely  distant  nations,  in  climates  most  different,  man  seems  to  have 
adopted  the  same  style  of  construction,  the  same  ornaments,  the  same 
customs,  and  to  have  placed  himself  under  the  government  of  the  same 
political  institutions.  Mayer,  describing  one  of  his  trips,  says:  "I  con- 
stantly saw  serpents  in  the  city  of  Mexico  carved  in  stone,  and  in  the 
various  collections  of  antiquities."  The  symbolic  feathered  serpent 
was  by  no  means  peculiar  to  Mexico  and  Yucatan.  Squier  encountered 
it  in  Xicaraugua,  on  the  summits  of  volcanic  ridges;  even  among  our 
historic  Indian  tribes,  for  example,  among  the  Lenni  Lenape,  they 
called  the  rattlesnake  "grandfather"  and  made  offerings  of  tobacco  to 
it.  Furthermore,  in  most  of  the  Indian  traditions  of  the  Manitou  the 
great  serpent  figures  most  conspicuously. 

It  has  been  often  said  that  every  feature  of  the  religion  of  the 
new  world  discovered  by  Cortez  and  Pizarro  indicates  a  common  origin 
for  the  superstitions  of  both  continents,  for  we  have  the  same  worship 
of  the  sun,  the  same  pyramidal  monuments,  and  the  same  veneration 
of  the  serpent  everywhere.  Thus  it  will  be  seen  that  the  serpent-symbol 
had  a  wide  acceptance  upon  this  continent  as  well  as  the  other,  and 
among  the  uncivilized  and  semibarbaric  races;  that  it  entered  widely 
into  all  symbolic  representation  with  an  almost  universal  significance. 
Perhaps  the  latest  evidences  of  this  belief  may  be  seen  in  the  tradition 
ascribing  to  St.  Patrick  credit  for  having  driven  all  the  serpents  from 
Irish  soil,  or  in  the  perpetuation  of  rites,  festivals,  and  representations 
whose  obsolete  origin  is  now  forgotten.  For  instance,  the  annual  ^fay- 
day  festival,  scarcely  yet  discontinued,  is  certainly  of  this  origin,  yet 
few,  if  any,  of  those  who  participate  in  it  are  aware  that  it  is  only  the 
perpetuation  of  the  vernal  solar  festival  of  Baal  and  that  the  garlanded 
May-pole  was  anciently  a  phallic  emblem. 

Among  men  of  my  own  craft,  the  traditions  of  .^sculapius  are 
prevalent,  ^sculapius  is,  however,  inseparably  connected  with  the 
serpent-myth,  and  in  statues  and  pictures  is  almost  always  represented 
in  connection  with  a  serpent.  Thus  he  is  seen  with  the  Caduceus. 
or  the  winged  wand  entwined  by  two  serpents,  or  sometimes  with 
serpents'  bodies  wound  around  his  own:  rarely  if  ever  without  some 
serpent-emblem.  Moreover,  the  Caduceus  is  identical  with  the 
simple  figure  of  the  cross,  by  which  its  inventor  Thoth  is  said  to 


lATROTHEUKGIC  SYMBOLISM.  361 

have  symbolized  the  four  elements  proceeding  from  a  common 
center.  In  connection  with  the  cross  it  is  interesting  also  that 
in  many  places  in  the  East  serpent-worship  was  not  immediately 
destroyed  by  the  advent  of  Christianity.  The  Gnostics,  for  example, 
among  Christian  sects,  united  it  with  the  religion  of  the  cross,  as 
might  be  shown  by  many  quotations  by  religious  writers.  The  ser- 
pent clinging  to  the  cross  was  used  as  a  symbol  of  Christ,  and  a  form 
of  Christian  serpent-worship  was  for  a  long  time  in  vogue  among 
many  beside  the  professed  Ophites.  In  the  celebration  of  the  Bacchic 
mysteries,  the  mystery  of  religion,  as  usual  tbrougliout  the  world,  was 
concealed  in  a  chest  or  box.  The  Israelites  had  their  sacred  Ark,  and 
every  nation  has  had  some  sacred  receptacle  for  holy  things  and  sym- 
bols. The  worshippers  of  Bacchus  carried  in  their  consecrated  baskets 
the  mystery  of  their  God,  while  after  their  banquet  it  was  usual  to 
pass  around  the  cup,  which  was  called  the  "Cup  of  the  Good  Daemon," 
whose  symbol  was  a  serpent.  This  was  long  before  the  institution  of 
the  rite  of  the  last  supper.  The  fable  of  the  metbod  by  which  the  god 
^sculapius  was  brought  from  Epidaurus  to  Rome,  and  the  serpentine 
form  in  which  he  appeared  before  his  arrival  in  Rome  for  the  purpose 
of  checking  the  terrible  pestilence,  are  well  known.  The  serpentine 
column  which  still  stands  in  the  old  race-course  in  Constantinople  is 
certainly  a  relic  of  serpent-Avorship,  though  this  fact  was  not  appre- 
ciated by  Constantine  when  he  set  it  up. 

The  significance  of  the  ark  is  not  to  be  overlooked.  First,  Noah 
was  directed  to  take  with  him  into  the  ark  animals  of  every  kind.  But 
this  historical  absurdity,  read  aright  and  in  its  true  phallic  sense, 
means  that  the  ark  was  the  sacred  Argha  of  Hindoo  mythology,  which, 
like  the  moon,  in  Zoroastrian  teachings,  carries  in  itself  the  germs 
of  all  things;  read  in  this  sense  the  thing  is  no  longer  incompre- 
hensible. As  En  Arche  (in  the  beginning),  Elohim  created  the  heavens 
and  the  earth,  so  in  the  ark  were  the  seeds  of  all  things  preserved  that 
they  might  again  repopulate  the  earth.  Thus  this  ark  of  Noah,  or  of 
Osiris,  the  primeval  ship  whose  navigation  has  been  ascribed  to  various 
mythological  beings,  was  in  fact  the  moon,  or  the  ship  of  the  sun,  in 
which  his  seed  is  supposed  to  be  hidden  until  it  bursts  forth  in  new 
life  and  power.  But  the  dove,  which  figures  so  conspicuously  in  the 
Biblical  legend,  was  consecrated  to  Venus,  in  all  her  different  names, 
in  Babylon,  in  Syria,  in  Palestine,  and  in  Greece;  it  even  attended 
upon  Janus  in  his  Voyage  of  the  Golden  Fleece.  And  so  the  story  of 
Jonah  going  to  Joppa,  a  sea-port  where  Dagon,  the  fish-god,  was  wor- 


362  THE    HISTORY    OF    MEDICINE. 

shipped,  and  of  the  great  fish,  bears  a  suspicious  relation  to  the  same 
cult,  for  the  fish  was  revered  at  Joppa  as  was  the  dove  at  Xineveh. 

It  has  been  impossible  to  disassociate  serpents  and  serpent- 
worship  from  -^sculapius.  This  is  not  because  this  mythological 
divinity  is  supposed  to  have  been  the  founder  of  our  profession,  but 
because  he  has  given  at  all  times  a  serpentine  form  and  has  been, 
apparently,  on  the  most  familiar  terms  with  the  animal.  Pausanias, 
indeed,  assures  us  that  he  often  appeared  in  serpentine  form,  and  the 
Roman  citizens  of  two  thousand  years  ago  saw  in  this  "God  in  reptilian 
form  an  object  of  high  regard  and  worship."  When  this  divinity  was 
invited  to  make  Rome  his  home,  in  accordance  with  the  oracle,  he  is 
represented  as  saying: — 

"I  come  to  leave  my  shrine; 
This  serpent-view,  that  with  ambitious  play 
My  staff  encircles,  mark  him  every  way; 
His  form — though  larger,  nobler — I'll  assume. 
And,  changed  as  gods  should  be,  bring  aid  to  Rome." 

(Ovid,  Metamorphoses,  XV.) 

When  in  due  time  this  salutary  serpent  arrived  upon  the  island 
in  the  Tiber,  he  began  to  assume  his  natural  form,  whatever  that  might 
have  been: — 

"And  now  no  more  the  drooping  city  mourns; 
Joy  is  again  restored  and  health  returns." 

Considering,  then,  the  intimate  relation  between  the  founder  of 
medicine  and  the  serpent,  it  will  not  seem  strange  that  the  serpent- 
myth  is  a  subject  of  keen  interest  to  every  student  of  the  history  of 
medicine. 

This  devotion  to  serpent-worship  appears  to  have  lingered  a  long 
time  in  Itah%  for  so  late  as  the  year  1001  a  bronze  serpent  on  the 
basilica  of  St.  Ambrose  was  worshipped.  De  Gubernatis,  speaking 
of  it,  says:  "Some  say  it  was  the  serpent  of  ^sculapius,  others  Moses, 
others  that  it  was  the  image  of  Christ;  for  us  it  is  enough  to  remark 
that  it  was  a  mythological  serpent  before  which  the  Milanese  mothers 
offered  their  children  when  they  suffered  from  worms,  in  order  to 
relieve  them":  a  practice  which  was  finally  suppressed  by  San  Carlo. 
Moreover,  there  has  persisted  until  recently  what  is  called  a  snake 


lATROTHEURGIC  SYMBOLISM.  363 

festival  in  a  little  mountain-churcli  near  IS^'aples,  where  those  partici- 
pating carry  snakes  around  their  persons,  the  purpose  of  the  festival 
being  to  preserve  the  participants  from  poison  and  sudden  death  and 
bring  them  good  fortune  (Sozinskey). 

The  power  of  the  sun  over  health  and  disease  was  long  ago  recog- 
nized in  the  old  Chaldean  hymn,  in  which  the  sun  is  petitioned  thus: — 

"Thou  at  thy  coming  cure  the  race  of  man; 
Cause  the  ray  of  health  to  shine  upon  him; 
Cure  his  disease." 

Probably  some  feeling  akin  to  that  voiced  in  this  way  gave  rise 
to  the  following  beautiful  passage  in  Malachi,  iv,  2:  "The  Sun  of 
Eighteousness  shall  arise  with  healing  in  his  wings." 

As  a  purely  medical  symbol  the  serpent  is  meant  to  symbolize 
prudence;  long  ago  men  were  enjoined  to  be  as  "Wise  as  serpents,"  as 
well  as  harmless  as  doves.  In  India  the  serpent  is  still  regarded  as  a 
symbol  of  every  species  of  learning.  It  has  also  another  medical  mean- 
ing, namely,  convalescence,  for  which  there  is  afforded  some  ground  in 
the  remarkable  change  M'hich  it  undergoes  every  spring  from  a  state 
of  lethargy  to  one  of  active  life. 

According  to  Ferguson,  the  experience  of  Moses  and  the  Children 
of  Israel  with  brazen  serpents  led  to  the  first  recorded  worship  paid 
to  the  serpent,  which  is  also  noteworthy,  since  the  cause  of  this  ador- 
ation is  said  to  have  ])een  its  intrinsic  healing  power.  The  prototype 
of  the  brazen  serpent  of  Moses  in  latter  times  was  the  Good  Genius,  the 
Agatliodcemon  of  the  Greeks,  which  M^as  regarded  always  with  the  great- 
est favor  and  usually  accorded  considerable  power  over  disease. 

The  superstitious  tendency  to  regard  disease  and  death  as  the 
visitation  of  a  more  or  less  capricious  act  by  some  extramimdane  power 
persists  even  to  the  present  day.  For  example,  in  the  Episcopal  Book 
of  Common  Prayer  it  is  stated,  in  the  Order  for  the  Visitation  of  the 
Sick:  "Wherefore,  whatsoever  your  sickness  be,  know  you  certainly 
that  it  is  God's  visitation";  while  for  relief  the  following  sentiment 
is  formulated  in  prayer,  "Lord,  look  down  from  heaven,  behold,  visit, 
and  relieve  these  thy  servants,"  thus  voicing  the  very  ideas  which  were 
current  among  various  peoples  of  remote  antiquity,  and  eliminating 
all  possibility  of  such  a  thing  as  the  regulation  of  disease  or  of  sanitary 
medicine. 

I  began  this  essay  with  the  intention  of  demonstrating  the  recon- 


364  THE    HISTORY    OF    MEDICINE. 

elite,  but  positive,  connection  between  the  symbolism  of  the  church  of 
to-day  and  the  phallic  and  iatric  cults  of  prechristian  centuries.  As  a 
humble  disciple  of  that  iEsculapius  who  was  the  reputed  founder  of 
our  craft,  I  have  felt  that  every  genuine  scholar  in  medicine  should  be 
familiar  with  these  relations  between  the  past  and  the  present. 


INDEX. 


Advances  in  other  sciences,  153 

^Egidius,  77 

yEsclepiadse,  11 

^sculapiiis,  7 

.Etius,  49 

Age  of  foundation,  12 

Age  of  renovation,  12 

Age  of  transition,  12 

Agnew,  D.  Hayes,  295 

Akenside,  2l;5 

Albinns,  164 

Albucasais,  68 

Alchemists  and  charlatans,  the,  187 

Alchemy,  141 

Alexander  of  Tralles,  50 

Alexandria,  library  of,  31 

school  of,  32 
Alkindns,  60 
Ambulant  physicians,  17 
Amendment  in  medical  affaire,  151 
American  teaching  of  to-day,  298 
Amphitheatres,  dissecting.  111 
Amussat,  269 

Antesthesia,  history  of,  300 
Anatomic  period,  12,  30 
Anatomy  and  physiology  of  Gralen,  39 
Anatomy,  chairs  of,  111 
Andral,  245 
Andrv.  177 
And,  215 
AniTnalcniists,  183 
Animism^  19(5 
Animists,  183 

Antiseptrics,  history  of,  317 
Antylhis,  51 
Arabic  period,  12,  57 

review  of  the,  97 
Archiaters,  53 
.Aretaeus,  36 
Argentier,  Jolin.  146 
Aristotle,  28 
Arlt,  253 

Arnold  de  Villeneuve,  88 
Asclepiades  of  Bithynia,  44 
Aselli,  160 
Astrology,  141 
Astrnc,  138,  214 
Aubrey,  183 

Auenbrugger.  Leopold,  210 
Auscultation,  262 
Avenzoar,  64 
Averroes,  64 
Avicenna,  61 

Baehe,  Franklin,  287 
Baclitischua,  59 
Bacon,  Lord.  153 
Bacon,  Roger,  68 
Baglivi,  162,  172 
Baillie,  213,  224 


Barba,  165 

Barthez,  201 

Bartholin,  161,  184 

Biu-ton,  John  Rhea,  293 

Baseilhac,  214 

Bayle,  245 

Bell,  Benjamin,  219 

Bell,  John,  219 

Bell,  Sir  Charles,  219,  274 

Bellini,  172 

Benivieni,  114 

Bernard,  Claude,  247 

Bernard,  the  Provincial,  77 

Bhang,  301 

Bichat,  160,  162,  164,  208 

Bienaise,  177 

Bigelow,  Heiny  J.,  295 

Bilguer,  215 

Billroth,  Tlieodor,  264 

Blumenbach,  222 

Boerhaave,  193 

influence  of,  168 

Boerhaave's  clinics,  167 

system  of  medicine,  194 
theory  of  inflammation,  164 

Bonnet,  270 

Bordeu,  201 

Borelli,  160,  172 

Borri,  176 

Botal ,  Leonard ,  146 

Bouehut,  259 

Bover,  267 

Boyleston,  Dr.,  279 

Boiiillaud,  244 

Boulot,  177 

Bomgeois,  Louise,  166 

Braid,  Dr.  James,  204 

Braidism,  204 

Brainard,  Daniel.  295 

Brasdor.  214 

Brighani.  290 

Brisseau,  178 

Brissot,  practice  of  bleeding  by,  118 

British  surgeons,  modern,  275 

Brodie.  Sir  Benjamin,  273 

Broussais.  243 

Brown.  Dr.  John.  205 

Browne.  Sir  Thomas.  175 

Brunner.   183 

Brunonian  doctrine.  205 

Buck.  Curdon,  293 

Bnnistead,  Freeman  J.,  289 

Burking.  231 

Cabalistic  theory.  141 

Csesarean    operation,   re-eatabliahment 

of.  134 
Camper.  Peter.  219 
Cardan,  Jerome,  142 
Cardinal  powder,  165 

(305) 


366 


INDEX. 


Casserius,  162 

Cataract,  first  recognition  of  its  seat, 

178 
Cathedral  medical  schools,  89 
Cell,  the  term,  153 
Cellular  pathology,  256 
Celsus,  Cornelius,  34 
Cesalpinus,  155 
Chamberlain's   invention    of   obstetric 

forceps,  166 
Chapman,  Nathaniel,  286 
Charitable  institutions,  ancient,  55 
Chemical  system  of  medicine,  169 
Cheselden,  216 
Cheyne,  John,  248 
Chinese,  medicine  of  the,  5 
Chiron,  7 
Chloroform,  discovery  of,  303 

Simpson's  introduction  of,  313 
Chopart,  314 
Circulation,  capillary,  discovery  of.  158 

discovery  of  the,  155,  160 
lesser.  112 

failure  to  discover  the,  113 
Civiale,  269 
Clark,  Alonzo,  288 
Classification  of  events  in  the  history 

of  medicine.  12 
Clinical  teaching,  earliest  systematic, 

167 
Cloquet.  269 

Cnidus,  Temple  of  -li^seulapius  at,  9 
Cocaine,  314 
Coction.  doctrine  of,  24 
Colles.  Abram.  248 
Collot  family  of  lithotomists,  177 
Colonial  physicians,  276 
Columbus.  107.  155 
Compass,  invention  of  the,  99 
Constantine  the  African,  74 
Contrastimolo.  240 
Cooper,  Bransbv,  273 

Samuel,  273 

Sir  Astley,  271 
Cornelius  Agrippa.  139 
Corpuscles  of  tlie  blood,  first  discovery 

of.  158 
Corvisart.  168 
Cos.  19 

Temple  of  .f^sculapius  at,  9 
Cosmogony,  Greek.  13 
Countess's  powder,  165 
Cowper.  158.  182.  183 
Cox,  John  R.,  286 
Crisis,  doctrine  of,  25 
Cruveilhier.  245 
Cullen.  William.  198 
Currie,  229 
Czermak,  2.53 


Dalton.  .lohn  C.  288 
Darwin,  Charles,  237 

Erasmus.  202 
Daviel.  215 
De  Graaf.  183 
De  Haen.  2lM) 

De  la  Marche.  Marguerite.  182 
Delafield.  Edward.  290 
De  Launav.  177 
Delamotte',  166,  182 
Delpech.  268 
De  Marque,  177 
Denis,  .Jean  Baptiste.  176 
Denman,  Thomas,  220 
Dental  surgery,  the  first  col.ege  of,  .341 
Dentistry,  ancient  and  mediaeval,  332 

as  a  specialty  of  medicine,  337 

in  America,  341 

of  prehistoric  times.  331 

relation  of.  to  modern  surgical  pa- 
tiioloev,  340 
Desault.  P.  J.r"214.  267 
Deventer.  I(i6 
Dewees,  ^^■illiam  P..  288 
Diagnosis,  exact  methods  in.  263 
Dionis,  Pierre.  177 
Dissection,  ceremonials  previous  to.  149 

difficulties  attending.  103 

of  human  bodies,  32 
Doctor's  mob  in  Xew  York.  284 
Dodart.  172 
Donders,  253 

Eberle,  John,  286 

Eclectics,  14.  46 

Embalming,  3 

Empedocles.  17 

Empirics.  14 

Engraving.  100 

Engravings,  first  anatomical,  112 

Epidaurus,  Temple  of  ^sculapius  at, 

10. 
Erasistratus.  .34 
Erudite  period.  13 
Esquirol,  228 

Ether,  sulphuric,  as  an  anaesthetic,  302 
Eustaehius.  107 
Eve.  Paul  F.,  294. 


Fabre,  164 

Fabricius  ab  Aquapendente,  109 

Fabricius  Hildanus.  110,  178 

Fallopius.  109 

Faust.  100 

Fermentation,  the  causes  of,  319 

Fernel.  Jean.  115 

Fidelis,  on  legal  medicine,  167 

Filkin,  217 

First  hospitals  in  United  States,  283 


INDEX. 


367 


First  medical  schools  in  the  United 
States,  281 

Flint,  Austin.  288 

Fothergill.  John,  212 

Francis,  .lohn  W.,  286 

Frank,  J.  P..  212 

Frere,  Come.  214 

Frere,  .Tactjues,  177 

Frick,  200 

Fuchs,  253 

Functions  of  the  spinal  nerves,  dis- 
covery of  the,  248 

Gaddesden,  John,  87 

Galen,  anatomy  and  phyaiology  of,  39 

Galen,  Claudius,  30 

Galen's  influence,  43 

theories,  39 
(Gardiner,  199 
Garenfjeot,  213 
Gaub.  195 

Gerard  of  Cremona,  90 
Gerdy.  270 

Germicides,  internal  use  of,  329 
Germ-theory  of  disease,  259 

what  it  means,  323 
Gibson,  William,  2(53 
Gilbert,  of  England,  87 
Gimbernat,  215 
Glisson,  163,  183 
Goerter,  163 
Goode.  John  Mason,  247 
Goodwin.  160 
Goursaud,  177 
Graefe,  253 
Graves,  Robert.  248 
Gray,  John  P.,  290 
Greece,  medicine  of,  16 
Greek  period,  12.  49 
Gregory,  199 
Griesinger.  254 
Gross,  Samuel  D.,  294 
Guillemeau,  Jacob,  131 
Gunn,  Moses,  295 
Guthrie,  273 
Guttenberg.  100 
Guy  de  Chauliac,  93 
Gymnasia,  the.  18 
Gymnasiarch,  18 
Gymnast,   18 

Hahn.  229 
Hahnemann.  241 
Haller,  160,  162,  163,  220 
Halv-Abbas,  61 
Hamilton.  Frank  H.,  293 
Harvev.  Gideon,  175 

William,  155 
Hasheesh,  .301 
Hasner,  253 


Havers,  183 

Heberden,  212 

Hebra,  253 

Hebrews,  medicine  of  the,  3 

Heister,  215 

Helvetius,  160 

Henle,  254 

Henri  dc  Mondeville,  88 

Herophilus,  33 

Hessenfratz,  KiO 

Heurne,  Otto  de,  introduction  of  bed- 
side instruction  by,  167 

Hevvson,  161 

Hiera   Hiblos,  3 

Highmore,  183 

Hippocrates,  19 

Hirudinomania,  244 

Hoboken,  183 

Hodgen,  John  T.,  294 

Hoffmann.  Cliristopher  Ludwig,  200 

Hoffmann.  Friedrich.  197 

Hoffmann's  dynamic  system,  197 

Holmes,  Oliver  Wendell,  290 

Home,  Sir  Everard,  224 

Homa'opathy,  241 

Horner,  W."E.,  287 

Hospitals  and  clinics,  231 

Howard.  John,  212 

Hnfeland.  240 

Humanization  of  vaccine-virus,  228 

Hunter.  John,  164,  218 
William,  218 

Hunter's  studv  of  the  lymphatic  sys- 
tem, the,  161 

Huxham.  John,  212 

Hvdrotlierapeutic  system,  255 

Hydrotherapy,  229  ' 


latrochemical  system,  169 

latroliptes,  18 

latromeclianical  school,  171 

Infarctus,  doctrine  of,  201 

Influence,  of  botany  on  medicine,  237 
of  chemistry  on  medicine,  238 
of  Darwin  and  Spencer  on  medi- 
cine, 237 
of  Harvey's  discovery,  159 
of  physics  on  medicine,  2.38 
of  the  art  of  printing,  100 
of  tlie  Frencli  Revolution,  191 
of  the  Northern  invaders,  71 
of  the  occult  sciences,  1.39 
of  the  Salerian  school,  81 
of  zoology  on  medicine,  238 

Inoculation,     against     small-pox,     in 
America,  279. 

Inoculation,  preventive,  against  small- 
pox, 225 
with  cow-pox.  the  first.  226 


368 


INDEX. 


Irritability  of  tissues,  discoverj'  of.  163 
Isopathy,  241 

Jackson,  Charles  T.,  310 

.Jacobus  Sylvius,  103 

•Jiiger,  253 

Jenner,  Edward,  226 

Jesuit  powder,  165 

Jews,  prejudice  against  the,  233 

John  Actuarius,  66 

John  of  Procida,  79 

Jouberf  s  Popular  Errors,  147 

Kanipf,  201 
Kepler,  162 
Keves,  289 
Kirkbride,  290 

Laennec,  262 

Lamballe,  Joubert  de,  270 

Lancisi's  clinic,  168 

Lanfranc,  91 

l^angenbeck.  Bernhard  von,  264 

Larrev.  267 

Lavoisier,  160.  191 

Lawrence,  Sir  William,  274 

Le  Boe.  167,  169 

Le  Cat.  214 

Le  Dran,  213 

Leonicenus,  Nicholas.  101 

Lettsoni,  213 

Leeuwenhoek.  158 

Levret's    modification     of    obstetrical 

forceps.  166 
Ligatures,  first  use  of,  in  amputations, 

127 
Linacre,  Thomas.  101 
Linna*us,  191 
Lisfranc.  269 
Lister.  261 
Lister's  studies  and  methods.  325 

work,  benefits  of,  327 
Liston,  Robert,  274 
Lithotomy,  lateral,  inventor  of.  177 
Lizars,  John,  274 
Long.  Crawford.  304 
Lorry,  228 
Louis,  246 
Lvmph.   discovery    of  the   circulation 

of,  158 

Machaon,  10 

McClellan.  George.  293 

McDowell,  Ephraim,  267,  292 

Magati,  176 

Magendie.  246 

Magic,  141 

Magnetism,  animal,  203 

Maimonides.  65 

Maitre.  Jean,  178 

Malgaigne.  270 


Malpighi.  158 

Mandragora,  301 

Marcellus  Donatus,  115 

March.  Alden,  295 

Marchetti.  158,  176 

Mareschal.  Georges,  178 

Marinus,  42 

Marjolin.  269 

Mascagni.  161 

Mauriceau,  166.  182 

Mauthner.  253 

Mavow,  160 

Mead,  Richard.  213  • 

Mechanico-dynamic    system    of    medi- 
cine, 197 

Meckel.  162 

Medi  rtl  journal  in  the  United  States, 
first,  285 
jurisprudence,  beginning  of,  166 
school  of  tlie  natural  sciences,-  258 
study  under  preceptors.  277 
systems,  promulgation  of,  152 

Medici  puri.  pretensions  of,  189 

Medicine,   and   surgery,   approach    of, 
147 
dogmatic  school  of,  13 
Imperial  school  of.  at  Pekin,  6 
physiological  theory  of.  243 
separation  of  priesthood  from,  147 

Meibom.  184 

Meigs.  John  Forsyth.  289 

Melampus,  6 

Mesmer.  Frank.  203 

Mesmerism,  203 

Mesne.  60 

Methrlism.  13,  45 

Microscope,  100 

Midwifery     during     the     seventeenth 
century,  advance  of,  182 

Midwives.  165 

Mondino.  92 

Monro.  Alexander.  Sr..  216 

Alexander,  second  and  third,  216 
Donald.  216 

Monroes,  the  two.  164 

Montpellier.  the  school  of,  86 

Morand.  213 

Morel.  176 

Morgagni.  224 

Morton,  Richard.  175 
William  T.  G..  306 

Mott.  Valentine.  293 

Miiller.  222 

Munich  Clinical  Sdiool.  258 

Muralt.  ISO 

Mutter,  Thomas  D..  293 

Mystic  period.  12 

Natural   history,  the  school  of,  249 
Natural  philosophy,  the  school  of,  249 


INDEX. 


369 


Needham,  183 

Nglaton,  270 

Nepenthe,  301 

New  Vienna  School,  250 

Nitrous-oxide  gas,  303 

Nominalist,  69 

Nuck,  183 

Obstetrical  forceps,  invention  of  the, 

166 
Obstetricians  and  gynaecologists, 

American,  295 
Obstetrics,  development  of,  166 
Oken,  249 

Oplithalmoscope,  263 
Oppolzer,  253 
Oribasius,  48 

Orthopaedics,  o-  igin  of  name,  177 
Ovariotomy,  the  first,  267 

Pacchioni,  183 

Palfyn's  obstetrical  forceps,  166 

Paracelsus,  143 

Pare.  Ambroise,  123 

Pare  and  the  surgeons  of  St.  C6me,  131 

Park.  Henry,  217 

Parker,  Willard,  293 

Paulus  iKgineta,  51 

Pecquet,  161 

Percussion,  invention  of  the  art  of,  210 

Pergamos,  library  of,  30 

Periodic  physicians,  17 

Peruvian  bark,  discovery  of,  164 

Petit,  J.  L.,  ^13 

Pen.  166 

Peyer.  183 

Peyronie.  213 

Pfeufer,  254 

Pharmacopolists,  54 

Philosophic  period,  12,  18 

Phrenology,  163.  242 

Physical  examination,  methods  of,  263 

Physick.  Philip  S..  291 

Physiological  medicine,  253 

Piiiel.  163.  196,  206,  228 

Piorrv.  262 

Pitard,  John,  92 

Plater.  Felix,  118 

Plato,  27 

Pleximeter.  263 

Podalirius.  10 

Porta,  Oiovanni  Batista,  118 

Portal,  223 

Paul,  166.  182 
Pott.  Percival.  217 
Pravaz,  269 
Praxagoras,  27 
Priessnitz,  255 
Primitive  period,  12 
Pringle.  Sir  John,  212 


Ptolemy  Soter,  31 
Purkinje,  222 
Purmann,   180 
Pythagoras,  15 

Quesnay,  173,  214 
Quintus,  42 

Kadcliffe,  213 

Kademacher,  254 

Rapid  multiplication  of  scientific  liter- 
ature, 239 

Rasori,  240 

Rau,  180 

Ray,  Isaac,  290 

Ray,  John,  289 

Realism,  206 

Realist,  69 

Receptaculum  ehyli,  discovery  of,  161 

Reflex  action,  discovery  of,  248 

Reform  period,  13 

Regulation  of  practice  in  colonial 
times,  285 

Reil,  202 

Religious  orders  and  the  sick,  95 

Rembert  Dodoens,  115 

Reuss,  253 

Rhazes,  60 

Rhinoplasty,  176 

Rhodes,  Temple  of  ^sculapius  at,  8 

Richerand,  267 

Richter.  August  Gottleib,  216 

Riolan.  128 

Rivinius.  183. 

Rodger.  J.  K..  293 

Rocschlaub.  240 

Roger  of  Parma,  78 

Roland  of  Parma.  78 

Rolfink.  188 

Rome  during  the  Greek  period,  53 

Rokitanskv,  250 

Roser.  253 

Rousset  and  tiie  Csesarean  operation, 
13-x 

Roux,  269 

Rufus  of  Ephesus.  42 

Rush,  Benjamin,  206,  283 

Ruysch,  158 

Sabatier,  214 

Sacred  period,  12 

Salernum,  school  of,  72 

Sandifort,  219 

Sands,  Henry  B.,  293 

Sanson.  269 

Santoro,  171 

Santoro's  thermometer,  171 

Sauvage,  196 

Saviard,  177 

Scalpel,  first  use  of,  in  di.ssecting,  112 


370 


INDEX. 


Scarpa,  162,  215 

Schafhausen.  183 

Schneider,   162,  184 

School  of  rational  medicine,  254 

Scientific  societies  and  journals,  origin 
of,  154 

Scultetus,  180 

Seminalism.  259 

Serapion,  60 

Sfcivetus.  Michael,  112,  155 

Severino,  119.  176 

Shoeffer,  100 

Shot    wounds,    the    new    teaching    of 
Pare  concerning,  132 

Sicgemundin.  Justine,  182 

Signiund,  253 

Simpson,  Sir  James  Y.,  274 

Sims.  J.  Marion.  296 

Skoda,  251 

Smellie,  William.  220 

Smellie's   modification   of   the   obstet- 
rical forceps,  166 

Smith,  Nathan  R.,  292 

Societies  and  academies,  foundation  of, 
235 

Soemmering.   162,  222 

Solidism,  198 

Spontaneous    generation    of    life    dis- 
proven,  321 

St.  came.  College  of,  f2,  122 

Stahl,   195 

Stahl's  pietistic  systt-.i,  195 

Steno,  Nicholas,  159 

Steno's  duct,  159 

Stethoscope.  262 

Stimolo  and  contrastimolo,  240 

Stoerck,  200 

Stokes,  William.  248 

Stoll,  200 

Student-life  during  the  fifteenth  and 
sixteenth  centuries,  148 

Surgery,  achievements  of,  263 
reasons  for  neglect  of,  120 

Swammerdam,  153,  183 

Sydenham.  152,  165,  173 

Sylvius.  167 

Syme,  Ja      s.  274 

Syphilis,  wide-spread  outbreak  of,  136 

Teeth,  substitutes  for  human,  335 

Telescope,  invention  of  the,  99 

Tenon,  215 

Thaer.  199 

Themison,  44 

Theory  of  excitement.  240 

Theosophy,  141 

Thermometer,  discovery  of  the.  171 

Thoth,  2 

Tourniquet,  invention  of,  176 

Tourniquet,  screw,  invention  of,  213 


Transfusion  of  blood  in  man.  the  first, 

176 
Travers,  Benjamin,  248,  273 
Treatment  of  the  insane,  improvement 

in,  228 
Troja.  228 
Trotula,  79 
Trousseau.  247 
Turck.  253 
Tyrrel,  273 

Universities  and  royal  scientific  socie- 
ties, 192 

Vaccination,  compulsory,  228 

in  the  United  States,  the  first,  279 

the  first.  227 
Vagadasastir.  4 
Valsalva.   176 

Van  Buren.  William  H.,  289 
Van  Helmont.  108 
Van   Helmonfs   system   of  medicine, 

168 
Van  Siebold.  216 
Van  Swieten.  168 
Van    Swieten    and    the    Old    Vienna 

School,  199 
Velpeau.  270 
Venesection,  first  account  of,  10 

revival  of.  118. 
Verulam,  Lord,  153 
Vesalius.  Andreas,  104 
Vicq  d'Azvr,  162,  164,  223 
Vidal,  269 
Vieussens,  162.  186 
Virchow,  Rudolph,  255 
Vitalism.  201 

modern.  255 

Wainman.  217 
Warren.  John  Collins,  291 
Waterhouse.  Dr..  279 
Wells.  Horace,  305 
Werlhof.  211 
Wharton.  183 
White.  Anthony,  216 

Charles.  216 
Wichman.  211 
William  of  Salicet.  91 
Willis.  Thomas.  163.  170 
Winslo\  ,  104.  223 
Winternitz.  255 
Wirsung.  183 
Wiseman.  Richard.  180 
Wistar.  Caspar.  286 
Wolf.  222. 

Wood.  Ceorge  B..  287 
Wren.  Sir  Christopher,  182 
Wunderlich,  250,  254 

Zeissel.  2.53 


An  Important  ^ook* 


ELEMENTS  OF  LATIN 


FOR 


STUDENTS  OF  MEDICINE  AND 
PHARMACY. 


h  Convenient  5ool<. 


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